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Medical Intake Form

Download the medical intake form below. Please do one of the following:

  1. Complete the form electronically and send it via email before your first consultation (email address is shown in the form)

  2. Print the form and fill it out manually, then bring it with you to your first consultation.


Form fields will not show properly in the pdf document if opened in your browser window. Please download to your computer and open it with Adobe PDF Reader to complete the form electronically.