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New Patient Forms

Hi!

I offer my patient forms online so they can be completed in the convenience of your own home or office.

If you do not already have AdobeReader® installed on your computer, Click Here to download.

 

Download the necessary form(s), fill out online after downloading them, and Email me your completed form(s) or print and bring it with you to your first appointment.

Please fill out the Covid Health Declaration at the bottom of the page as well.

**If any of the information on the Covid Health Declaration changes over the course of care, please make sure to inform me.

Thank you!

New Patient Informed Consent-1.jpg
New Patient HIPAA Privacy Notice with Si
New Patient COVID Release of Liability.j
New Patient History and Intake-1.jpg
Covid declaration

Covid-19 Health Declaration

How are you feeling today?

Thanks for submitting!

© nicole rodriguez DC 2023

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