PATIENT FORMS

​704-690-0017

An Integrative Health Care Practice In Charlotte NC

Upon confirmation of your initial appointment you should receive a notice from our electronic system to fill out our intake forms (With the exception of the Health Questionnaire).  Please complete the online forms as well as print and complete the Health Questionnaire prior to your visit.  Otherwise arrive 15 minutes prior to your appointment time to complete at our office. 

You may also click on the links below to download the forms needed for your first visit.  Please fill out and bring them with you to your appointment.  

Patient Registration Form (Now available through Patient Fusion Portal)

Health Questionnaire (Please print and complete)

Financial Responsibility And

Policy Statement (Now available through Patient Fusion Portal)

Medicare Exemption Form (MUST BE SIGNED BY MEDICARE PATIENTS) (Now available through Patient Fusion Portal)

Notice Of Privacy Practices &

Acknowledgement Form (Now available through Patient Fusion Portal)

*Read Notice of Privacy Practices and print and sign only the Acknowledgement Form

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