Forms
PRIMARY CARE PATIENT INTAKE FORMS
For Primary Care patients, please complete the following intake forms under Primary Care Patient Intake Forms. Once you set your appointment, print out forms, complete them and bring the forms on the day of your appointment.
Also, bring a list of all your current medications with dosages, your recent medical records, labwork and immunization records from past 2 years to your first appointment.
WEIGHT LOSS & WELLNESS INTAKE FORMS
For clients enrolling in our Wellness & Weight Loss program, please complete the following forms under Wellness and Weight Loss Intake Forms and bring to your appointment (in addition to the new patient intake forms).
Also bring a list of your current medications with dosages and your most recent labwork with you to your first appointment.
At the time of scheduling your initial appointment for the Eze Wellness and Weight Loss program, a $25 deposit fee will be collected to confirm your appointment. This fee will be applied toward the payment of your selected weight loss program at the time of your scheduled visit.
INTEGRATIVE / HOLISTIC HEALTH INTAKE FORMS
For clients enrolling in our Integrative / Holistic Health Programs, please complete the following forms and bring to your appointment (in addition to the new patient intake forms)
Also, bring a list of all your current medications with dosages, your recent medical records, labwork and immunization records from past 2 years to your first appointment.
