Akasha Center for Integrative Medicine

NEW PATIENTS

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Please take a moment to review and complete the following items:

• New Patient Checklist

• New Patient Intake Form
  

• Printable Patient Intake Form
  • Please bring the intake form 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 » (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 [Print Out/Fax]
  Release records/info TO Akasha Center FROM external source

• Request/Consent to Release Records & Information [Print Out/Fax]
  Release records/info FROM Akasha Center TO external source