Forms
NEW PATIENTS
- Online New Patient Intake Form (recommended)
All details are submitted and stored in a secure, encrypted format. For more information about the steps taken to protect your privacy, you can read our extensive security measures page. - Printable Patient Intake Form
Please bring Intake Forms with you to your first visit. It is also helpful to bring copies of past medical records to support your medical history. - Notice of Privacy Practice ยป (info only)
Disclosure of your patient privacy rights.
Read and understand your privacy rights of health and personal information. - Driving Directions & Parking
CONSENT to Release Records/Information:
- Request/Consent to Release Records & Information [Online | Print Out/Fax]
Release records/info TO Akasha Center FROM external source - Request/Consent to Release Records & Information [Online | Print Out/Fax]
Release records/info FROM Akasha Center TO external source