Printable Health Forms

 

All forms are available in PDF format. These files require Acrobat Reader. If you do not have Acrobat Reader, please download a free copy here.

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New Patients

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We ask that all new patients complete the forms in the Patient Introduction Packet. Forms can be downloaded below, or they can be mailed, faxed, or emailed to you. The completed forms should be brought with you at the time of your first appointment.

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• Welcome to Our Office

• New Patient Intake Forms

• Notice of Privacy Practice

• Medical Records Release

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Personal Injury

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A Personal Injury Form needs to be filled out if you are injured in an automobile accident that requires evaluation and treatment from our office.

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Difficult and Chronic Pain

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For those suffering from complex health, immune, food sensitivity, and/or neurological issues, patients will benefit by downloading and filling out three additional questionnaires: 

Metabolic Assessment Form, 

Brain Function Assessment Form (BFAF),

Brain Health and Nutritional Assessment Form (BHNAF)

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Treating Minors

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A Consent to Treat a Minor Form must be signed by a parent or legal guardian before a new patient under 18 years of age can be seen by a doctor at our office. Remember to bring this form on the patient’s initial appointment.

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Other Forms

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Brain Localization Form

Neurotransmitter Assessment Form (NTAF)
Child Neurotransmitter & Nutrition Questionnaire

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