Vital Health and Wellness // Contact Us

Forms

Augusta Swift, N.D.

Adult Intake Form: Download Here
Clinic Policy Agreement: Download Here
HIPAA Privacy Form: Download Here

Kevin Colling, D.C.

Patient Intake Forms: Download MS Word Format Here | Adobe PDF Format Here
Symptom Drawing: Download Here
Informed Consent: Download Here
Personal Injury Introduction Form - Auto Accident: Download Here
Metabolic Assessment: Download Here
Oswestry Back Pain and Disability Questionaire: Download Here

Mae Costello, L.Ac., LLC

Client Intake Form: Download Here
Payment and HIPAA Form: Download Here

Jill C. Ghormley, N.D., M.A.M.S.

Patient Introduction Form: Download Here
Patient Intake Form: Download Here
Patient Responsibility Form: Download Here
Insurance Questionnaire Form: Download Here

Courtney Jackson, N.D.

New Patient Forms: Download Here
Consent to Treat Form: Download Here
HIPPA Notice: Download Here
Office Policies: Download Here

Anne Meneakis, LCSW

Adult Private Consent to Treat Form: Download Here
Client Data Sheet: Download Here

Kirsten Schumaker, LMT

Confidential Health Profile and Client Information: Download Here
Health Insurance Information: Download Here
Insurance Information for MVA Claim: Download Here
HIPAA Form: Download Here
Guidelines for Referrals: Download Here

Kathy Sweeney, N.D.

Patient Intake Form: Download Here
Patient Responsibility Form: Download Here
Pediatric Intake Form (Birth - 5 years old): Download Here
Pediatric Intake Form (6 - 12 years old): Download Here

Tiffany Ueltschi, LMT, Doula

Massage Intake Form: Download Here
Maya Abdominal Massage Intake Form: Download Here

Links

Dr. Colling's Blog

Health Newsletters

2010

2009