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  • New Patient Form

    Please complete and submit this form prior to your appointment. This form has 6 pages that include registration, medical history, lifestyle information, and treatment waiver.
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  • Medical Information

    Please check all that apply.

  • Family Medical Information

    Please check all that apply to you biological relatives
  • Medical Information Cont.

  • Goals and Lifestyle Information


  • Photo ID

    Please upload a picture of your government issued picture ID (driver license, passport, military ID etc.)
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  • Treatment Waiver

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  • Telehealth Informed Consent Form

  • Clear
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