Exceptional Integrative & Alternative Medical Services... sINCE 1985

Patient Forms

In order to keep us running on time for all patients we ask that you arrive 10 minutes before your scheduled appointment time.

Please print forms, fill out forms, and bring to your appointment for the receptionist.

PATIENT FORMS:

Patient Registration Form

Medical History Form

Allergy History Form

Medical Symptoms Questionnaire Form

Financial Policy Form

Notice Of Privacy Practices Acknowledgement Form

HIPPA Release For Non-Compliant Communication Channels Form

Consent To Discuss Medical Records Form

Non- Medicare Provider Acknowledgement Form (Private Contract With Beneficiary)