Patient Intake Forms

Once you schedule an appointment with our office, we'll send digital intake forms to you. If you prefer to print out and complete our intake forms by hand, access these 5 PDFs: 

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1. Patient Information

2. Consent to Use Virtual Care Tools

3. Consent to Treatment

4. Notice of Privacy Practices Policy and Acknowledgement of Receipt

   1. Note, we just need the last page, "Acknowledgement of Receipt of Notice of Privacy Practices."

5. Financial Policy

6. Consent to Integrative Medicine

   1. *Required for anyone receiving integrative lifestyle counseling/internal medicine or our cellular energy optimization service, which is a combination of integrative counseling + OMT.

7. Medicare Private Contract

   1. *Required for anyone over 65+ receiving Medicare benefits or Medicare Disability. This form is a government-required form indicating you are aware we do not participate in insurance. ​

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