New Patients
PLEASE COMPLETE Intake and Consent Forms and bring with you to your first visit.
It is also helpful to bring copies of past medical records and information pertaining to current medications and supplements.
New Patient Intake Form
Complete medical history and symptom questionaire.
HIPPA Consent Form
Disclosure of your patient privacy rights.
Email Consent form
Consent to communicate via email.
PLEASE READ for your information only:
Notice of Privacy Practice (HIPPA)
Read and understand your privacy rights of health and personal information.
Email Disclosure
Read and understand your privacy rights for electronic exchange of health and personal information.
Other Forms
Request/Consent to Release Records & Information
Release records/info TO Iluminar FROM external source
Request/Consent to Release Records & Information
Release records/info FROM Iluminar TO external source