Intake and Consent Forms

Click the Download link beside the label of the form you need to complete.

Naturopathic Forms

ND Adult Intake Form 1 for
Dr. Susan Slipacoff, ND
ND Adult Intake Form 2 for
Dr. Susan Slipacoff, ND
ND Adult Intake Form  for
Dr. Polina Mak, ND
ND Adult Intake 
ND Adult Consent
ND Reassessment Form
IV Vitamin Drip Intake 
IV Consent Dr. Slipacoff, ND
IV Consent Dr. Fallico, ND
IV Pre-Treatment Form

ND Children's Intake
ND Consent of a Minor
Release of Records  for Dr. Susan Slipacoff, ND

Release of Records for Dr. Cardona, ND

Release of Records for Dr. Polina Mak, ND
Release of Records for Dr. Kristina Fallico, ND 

Chiropractic Forms

Intake and Consent
   

Massage Forms

Intake 
   

Benefits Forms

Benefit assignment electronic transmission authorization and consent form
   

Online Payment Processing Form

Credit Card Authorization Form Credit Card Processing Authorization
   
Patient Diet Tracker
Diet Tracking Form
Credit Card Processing Authorization