Forms for Our Consult

If we have scheduled a consult, please print and fill out the following forms prior to our appointment.  The second page of the Consent Form is for your information only. It is the HIPPA policy.


If you have any trouble printing out the forms, please contact me before our appointment.


Cancellation Policy - if you cancel an appointment with less than 24 hours notice, then you are responsible for a $50 cancellation fee.


In addition, if we schedule an appointment and I take the time to work up and send you a care plan prior to our consult, and then you cancel the appointment, you will be responsible for  the cost of a phone consult and the time taken to work on a personalized care plan.


For InfantForms_files/New%20History%20Infant%20form.pdfForms_files/New%20History%20Infant%20form_1.pdfshapeimage_1_link_0

For MomForms_files/New%20History%20Maternal%20form.pdfForms_files/New%20History%20Maternal%20form_1.pdfshapeimage_2_link_0

Consent and Financial Agreement FormForms_files/Consent%20and%20Financial%20Agreement%20Form.pdfForms_files/Consent%20and%20Financial%20Agreement%20Form_1.pdfshapeimage_3_link_0