Patient Forms

Insurance information

At this time we do not accept insurance. We do provide a document with the appropriate codes for the patient to submit to their insurance company.

If lab tests are needed, many of the labs we use will bill insurance. If you agree to any testing recommended by your doctor and your insurance company refuses to pay for the testing, you are responsible for the cost of the ordered tests.

We can never guarantee that your insurance company will reimburse you for your visits or cover the cost of your labs and imaging studies. You are ultimately responsible for the cost of your care at our office. It is recommended that you contact your insurance company if there is any question about coverage.

If you are new to our clinic, please click the following link(s) to print and fill out. Bring them with you to your first appointment. If you do not have Adobe Reader for PDF files, please click here to go to Adobe and download the reader.

New Patient Intake Forms
Release of Records

For your first visit, please:

Bring your New Patient Intake form

Bring Record Release form if applicable

Provide copies of blood work for the last three to five years (if you can)

Provide complete list of all your prescription medicines and supplements (with name, dosage and starting date) or you may bring the actual bottles

Bring 3-7 days of diet diary