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

*New Form – Medical History Form

Authorization to Release Health Information

*New Form – New Patient Information Form

* New Form – Verbal Authorization Form

 

Dr. Sullivan-Durand’s Integrative Medicine Evaluation Form

Dr. Sullivan-Durand’s MicroCurrent Evaluation Form