New Patient Forms

If it is more convenient for you, you can print and fill out the forms below before coming to the office. Click on the links below to open the forms. Make sure to print out, read, sign and bring in ALL of the REQUIRED forms with the ASTERISKS to your initial clinic visit.

IF YOU NEED HELP FILLING OUT THE FORMS, PLEASE COME IN 30-45 MINUTES EARLY FOR YOUR VISIT TO GIVE US TIME TO HELP YOU WITHOUT DECREASING THE TIME FOR ACTUAL TREATMENT.

If patient is a minor a parent or guardian MUST accompany minor patient to the first visit. Exceptions for parent or guardian accompanying the minor patient during ongoing treatment is based on type/area of treatment and understanding and signing of the Minor Patient Waiver below.

• New Patient Questionnaire
• Consent to Therapeutic Procedures
• Minor Patient Waiver
• Notice of Privacy Practice
• HMO Financial Policy Statement
• Financial Policy Statement
• Waiver of Liability - All Insurance Types
• Acknowledgement of Receipt of Privacy Practices

For Metabolic RX patients only, please print out, read, sign and bring in the following additional questionnaire.

• Metabolic RX Lifestyle Questionnaire

If you do not have the Adobe Acrobat Reader installed,
please follow the link below to install it.