Patient Forms

The following forms are in PDF File Format.
A PDF reader should already be on your computer, but if you need to download one you can click here to go to the Adobe PDF Reader. It is free.

Please Download, Print Out, Fill Out and bring the appropriate form(s) to your First Appointment or Send form (s) back prior depending upon the request of your Provider.

*New Form – Medical History Form

Authorization to Release Health Information

*New Form – New Patient Information Form

* New Form – Verbal Authorization Form

 

Allergy New Patient Forms
- For patients that are new to Dr. Sullivan-Durand’s practice with allergy-related concerns

Allergy Established Patient Forms
- For patients who are established with Dr. Sullivan-Durand’s practice and preparing for allergy testing

Allergy Testing Information and Consent Form
– General information regarding the allergy testing process, for your reference

Integrative Medicine Evaluation Form
- For patients that are new to Dr. Sullivan Durand’s practice with general Integrative Medicine concerns
*At this time, Dr. Sullivan-Durand is not accepting new general Integrative Medicine patients

MicroCurrent Evaluation Form
- For patients that are new to Dr. Sullivan-Durand’s practice and wish to pursue Frequency Specific Microcurrent treatments