Patient Forms

By completing the following forms below and sending them 3-4 business days prior your appointment, you will save significant time at the time of your scheduled visit. If you have any questions when filling out these forms, please do the best you can and our staff will be happy to help you with any questions you may have.

• Welcome Form.pdf
• Disclosure Statement and Informed Consent Form.pdf

For those who are “computer savvy”, the following Microsoft Word® .doc forms can be downloaded to your computer, filled out, saved and then emailed. This is the preferred route. If this is not an option, please printout the Adobe® PDF format, fill out and fax to (248) 594-9493.

New Patient Forms

Please complete the appropriate forms that relate to your upcoming appointment:

• Adult Intake Form .doc
• Adult Intake Form .pdf
• Child Intake Form .doc
• Child Intake Form.pdf
• Environmental Toxic Exposure Form .doc
• Colonic Intake Form.doc
• Colonic Intake Form.pdf
• FAQ Sheet & Instructions For Colon Hydrotherapy.pdf
• Constitutional Hydrotherapy Intake Form.doc
• Constitutional Hydrotherapy Intake Form.pdf
• LENS Intake Form.doc
• LENS Intake Form.pdf
• True-Rife Intake Form.doc
• True-Rife Intake Form.pdf
• Infrared Body Wrap Intake Form.doc
• Infrared Body Wrap Intake Form.pdf

Note: Some of the above files are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.