New Patient Forms
Forms
Kindly complete the digital New Patient Form below (take note that this form cannot be saved, so it is best to complete the entire form before submitting):
General Clinic Forms
- New Patient Intake Form will be available once your first office visit is scheduled.
- (If you need a paper copy, or for it to be emailed to you as a PDF, kindly let us know)
Please take note that our clinic has a Scent-Free (NO CHEMICALS ZONE) Policy:
We ask that ALL patients to refrain from wearing perfumes, colognes, and/or strong hair chemicals for your visits. Many of our patients, and some of our staff, suffer from Multiple Chemical Sensitivities; this condition can cause severe reactions such as headaches, stomach pain, and asthma attacks. We reserve the right to re-schedule your appointment if you are not in compliance with this policy.
Payment Methods:
We do not accept insurance, but as a courtesy, we will provide you with a superbill at the end of your visit. This superbill will have codes that may help you to get reimbursement for our services from your insurance company. Below is the payment methods that we do accept:
Most major credit cards, Flex spending accounts, and Checks.