New Patient Forms

New Patient Health History Forms – Required

Please use the link below to fill out your new patient paperwork. This information will be transferred securely to our office for your first appointment. If you cannot load and complete the paperwork ahead of time, please be advised that you will need to fill it out electronically when you arrive for your first appointment.

When making a new patient appointment you will be asked to pay a $100 non-refundable deposit over the phone. This will secure your spot with us and serve as a credit to be applied towards the remaining balance due on the new patient appointment. Should you need to reschedule your appointment, the deposit will go towards the rescheduled visit as long as 24 business hours notice is given. Thank you for your cooperation and understanding.

New Patient Intake Form

New Patient Information

Metabolic Assessment

 

HIPAA Privacy & Payment Agreement Forms – Required

Please download, complete and bring the following forms with you to your first appointment. If you cannot download the forms, please plan to arrive at least 15 minutes early so that you can fill out the paperwork in our office.

HIPAA-Consent for Use and Disclosure of Health Information

HIPPA-Notice of Privacy Practices

HIPAA-Acknowledgment of Receipt

Payment Agreement and Cancellation Policy

Additional Paperwork

Depending on your needs, you may be asked to fill out one or more of the following:

BHRT Consent Form

ePrescribing Consent Form

IV Therapy Consent