PATIENT FORMS

704-690-0017



An Integrative Health Care Practice In Charlotte NC

Please 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


Health Questionnaire


Financial Responsibility And

Policy Statement

 

Medicare Exemption Form (MUST BE SIGNED BY MEDICARE PATIENTS)


Notice Of Privacy Practices &

Acknowledgement Form


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