The doctor of the
future will give
no medicine, but interest his patients
in the care of the
human body,
in diet, and
in the cause and prevention of
disease."

~ Thomas Edison ~

           

 

New Patient Forms


*Print, complete, sign and date the appropriate forms.
Then bring with you for your first visit along with your insurance card and driver's license.

Note: The Patient Privacy Policy is provided in this link HIPPA Privacy Policy
It is provided for your review online or to print if you wish to retain a hard copy for your files.
You do not need to bring with you.

We request you print these forms SINGLE-SIDED only. 
Please do NOT print double-sided.

Adult intake and health history...[these forms are for adults 18 and older]

Pediatric intake and health history...[these forms are for patients UNDER 18]




 

 

 

The forms require Adobe Reader or other PDF reader.  If you need to install Adobe Reader,
it is available to download and install free of charge at the following link.

 


© 2010 McNeill Naturopathic Clinic, LLC - All rights reserved