Online Patient Forms

Patient forms are online so you can complete them in the convenience of your own home or office.

1. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download it for free.
2. Click on the necessary form, print it out and fill in the required information.
3. Fax us your printed and completed forms or bring them with you to your appointment and save time on your visit!

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Patient Forms 

This let’s us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

New Patients & Consultation Paperwork:

• New Patient Form No. 1
• Wellness Release Form
• Authorization Release Form
• Are You Sensitive to Electropollution?

Thermography Paperwork:

• Patient Information Sheet
• Patient Authorization
• Breast Thermography Confidential Questionaire
• Extended Breast Quenstionaire

Body Scan & Hair Scan Paperwork:

• Body/Hair Scan Retest Questionnaire Progress
• Hair Scan Information