New Patient Intake Forms
 

All forms are downloadable pdf's. Please use Adobe Acrobat Reader to print for your use.
You will need all five forms. Please return to Namaste Health Center at the address below,
prior to your first visit. Thank you.

The Health Status Interview is a live-form PDF file. Most people should simply print it and fill it out manually and send to us via postal mail, fax or drop it off prior to your appointment.

If you have up to date version of Adobe Acrobat Reader ver 10.x (or Preview ver 5.x on Mac), and you save your work frequently (it is a long form), you can fill it out on your computer and send us the completed PDF file (change the file name to yourname.pdf) via email. Do not attempt to do this unless you are an experienced computer user with up to date software and a stable computer.

Email here: info@namastehealthcenter.com

   
  Intake Form (11pages) fill out & return
   
  Financial Policies (1 page) sign & return
   
  Patient Consent Form (1 page) fill out & return
   
  Ackn. of Receipt of Privacy Practices Notice (1 page) fill out & return
   
  Privacy Practices Notice (2 pages) keep
     
  Pediatric Health History (3 pages, for children) fill out & return