Client Forms

Naturopathic and Midwifery Forms

Please fill out the forms that pertain to you. 

  • Adult Intake Form: Any new patient over the age of 13yo or current patients that have not been to the clinic.
  • Child Intake Form: Any new patient under the age of 13yo.  
  • HIPAA Compliance Form: All New patients or current patients that have not yet been to the clinic.
  • Visit Update Form: If you would like to pre-fillout this information please do. We will ask you to fill one out at the clinic prior to your return appointments.
  • Records Release Form: If you have labs, notes, or other information from a current or previous practitioner that may be helpful please fill this out.  

Adult_Intake_Form (pdf)

Download

Child_Intake_form (pdf)

Download

HIPPA_Practices_Form (pdf)

Download

Records_Release_Form__blank_ (pdf)

Download

Visit_Update_Form (pdf)

Download