Forms

Please print and fill out the indicated forms before your visit. You can also securely fax your filled out forms to 888-630-1986.

Adults (and young adults 12 and up)

Adult New Patient Intake  – Required

New Patient Consent To Treatment – Required

Pure Health Homeopathic Intake– Optional but helpful (you may be asked to fill this out at a later time)

Pure Health Membership Agreement – Optional

 

Children (Under 12)

Pediatric Intake (Age 12 and under)

Pure Health Homeopathic Intake– Optional but helpful (you may be asked to fill this out with your child at a later time)

 

  • The body has potential to heal itself with the right tools