View Patient Forms

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In order to ensure that all patients can open and print these documents, we’ve created them in Adobe (PDF) formats. If you don’t have the free Adobe Reader, you can download it from http://get.adobe.com/reader/

1. New Patient Welcome Letter (PDF file):

Includes instructions on what to bring to your appointment as well as directions and our contact information.

2. New Patient Intake Form (PDF file):

This must be filled out prior to initial visit.

3. New Patient EMG Form (PDF file):

This must be filled out prior to initial visit.

4. Follow-up Intake Form (PDF file):

Must be filled out prior to each follow-up visit.

5. Notice of Privacy Practices (PDF file):

This notice describes how medical information about you may be used and disclosed, and how you can access this information. We are required by a federal regulation (known as the HIPAA Privacy Rule) to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices. This office will not use or disclose your health information except as described in this Notice.

6. Authorization to Release Medical Information (PDF file)

 

7. Self Referral Packet (DOCX file)
8. Functional Medicine New Patient Intake Form