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                                               Forms and Fees

nurture_newpatientletter.pdf
File Size: 247 kb
File Type: pdf
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nurture2018payment_policy_and_fee_schedule.pdf
File Size: 56 kb
File Type: pdf
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notice_of_privacy_practices5:2015.docx
File Size: 248 kb
File Type: docx
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2018authorization_for_release_of_medical_records.pdf
File Size: 312 kb
File Type: pdf
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As of Fall 2018, intake medical history can be completed online securely, via Power to Practice.  Please send an email to  [email protected] with date of birth, mobile phone number, and full name in order to receive an invitation.


If instead it is necessary, the paper forms below may be printed, completed, and sent two weeks prior to your first appointment:

intake-demographics.pdf
File Size: 219 kb
File Type: pdf
Download File

patient_email_policy_and_consent.pdf
File Size: 230 kb
File Type: pdf
Download File

patient_consent_for_use_and_disclosure_of.pdf
File Size: 227 kb
File Type: pdf
Download File

health_information_history.pdf
File Size: 78 kb
File Type: pdf
Download File

family_history_.pdf
File Size: 38 kb
File Type: pdf
Download File

lifestyle_intake_.pdf
File Size: 64 kb
File Type: pdf
Download File

symptoms_review.pdf
File Size: 52 kb
File Type: pdf
Download File

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