Forms

Forms are part of every medical office. Please complete the that are important for your appointment.

PLEASE ARRIVE AT LEAST 15 MINUTES BEFORE YOUR SCHEDULED APPOINTMENT to complete your registration.

If you do NOT have your completed forms with you or, if you arrive more than 15 minutes later than your scheduled appointment time, it may be necessary to reschedule your appointment to be fair to other patients.  Thank you for helping us serve everyone to the best of our ability.

 

These forms are in electronic pdf format that you can complete online. Please fill in before printing.

If you do not have Adobe Acrobat, you can download the free reader HERE.

New Patient visit forms  (adult and child 11yr and over 2018-New Patient-Part 1    2018-New Patient-Part 2

New Patient visit forms (child – up to 10yo)   HERE

Privacy release forms     HERE

Breast History Form  HERE      

Thermography instructions   HERE

Homeoprophylaxis release form for Dr. Janet (HP)  HERE

Vaccine Consult release form  HERE

Matt Grant, DC   New patient forms  HERE

Environmental Allergy Treatment Instructions HERE

CANCELLATION POLICY

When you schedule an appointment, we hold this space for you. To be fair to our business and to other patients who could have been seen during that time, our cancellation policy will be strictly enforced.

In the event you must cancel and/or reschedule your first appointment, we require a minimum notice of two days, excluding Saturdays and Sundays. Patients who cancel without proper notice or fail to show for the scheduled appointment will be subject to a $225 charge.

>We also require two-day notice to cancel a follow-up visit. If an appointment is canceled without proper notice or if you fail to show, you will be subject to a $98 charge.

>We understand that sometimes emergencies arrive on short notice. If the new appointment is rescheduled and completed within five (5) days of the missed appointment, $150 of the cancellation charge will be applied towards the completed visit.

>If a follow-up appointment is rescheduled and completed within five (5) days of the missed appointment, $75 of the cancellation charge will be applied towards your next completed follow up visit.

 

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