Patient Forms
Patient Information Form
Consent to Treat Form
New Patient Initial Intake Form
Supplement and Medication Form
Release to Discuss
Privacy Practices
Record Release
Financial Policy
Consent to Treat Form
New Patient Initial Intake Form
Supplement and Medication Form
Release to Discuss
Privacy Practices
Record Release
Financial Policy
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The following is a list of forms that are necessary to fill out prior to your first
visit. For your convenience we have provided them here on the website to
decrease your waiting time upon arrival. If you prefer, you can fill out the
forms at our office at the time of your first visit. We just ask that you please
arrive at least 30 minutes prior to your appointment time in order to fill out
the necessary forms.
visit. For your convenience we have provided them here on the website to
decrease your waiting time upon arrival. If you prefer, you can fill out the
forms at our office at the time of your first visit. We just ask that you please
arrive at least 30 minutes prior to your appointment time in order to fill out
the necessary forms.
The following is a list of forms that your doctor may want you to fill
out after your initial office visit.
out after your initial office visit.
Homeopathic Form
Diet Diary
Women's Health History
Phone/PE consent form
Diet Diary
Women's Health History
Phone/PE consent form
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| ________________________________________________________________________________________________________________________ Champion Naturopathic Health, LLC 4035 W. Chandler Blvd. Ste 1, Chandler, AZ 85226 Ph: (480) 705-9611 Fax: (480) 756-6012 Copyright 2007, All rights reserved _________________________________________________________________________________________________________________________ |
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