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.

Dave Berger Intake Questionairre and New Patient Form

Medical History Form

Records Release Form

Patient Information Form

Authorization For Treatment Form

Dr. Sullivan-Durand’s Integrative Medicine Evaluation Form

Dr. Sullivan-Durand’s MicroCurrent Evaluation Form