Patient Forms

Pre-Appointment Forms

📁 Credit Card Agreement

📁 Acupuncture Evaluation

📁 Applied Kinesiology/Chiropractic Evaluation

📁 ChiroThin Doctor Supervised Weight Loss Program

📁 LENS Neurofeedback

📁 Optimal Health Evaluation/Blood Chemistry

New Patient Forms

Click each link below to download the new patient forms. Please completely fill out all forms prior to arriving for your first visit and bring all of them with you.

📁 New Patient Letter

📁 New Patient Application and Case History

📁 Disclosure Informed Consent Permission Natural Medicine Institute

📁 Beneficiary Form Not To Use Insurance or Medicare

📁 Acknowledgement of Receipt of Notice of Privacy Practices