- New Patient Intake Form (Online Form)
- New Patient Intake Form (Print Out/Fax)
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.
CONSENT to Release Records/Information:
- Release Information TO Akasha Center FROM external source (Online form)
Release Information TO Akasha Center FROM external source [Print Out/Fax]
- Release Information FROM Akasha Center TO external source [Print Out/Fax]
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