All New Patients/Clients
Click the image below: Online Patient Intake Form
SCROLL DOWN FOR COLONIC INSTRUCTIONS:
After completing the online form please send us a quick email to look for your form. In this email make sure to provide us with your full name, date of birth, and phone number where we can reach you to make your first appointment.
Please email us at firstname.lastname@example.org
Intake forms are necessary for:
2. Cupping/Gua Sha/Tuina/
3. GAINSWave/Shockwave treatments
4. Colon Hyrdo-Therapy
5. Medical Consultations with a Naturopathic Physician or an APRN
6. EFT Emotional Freedom Technique, or Nutritional Health Coaching
7. Fascia Blasting Treatment
For all other services mentioned below, a simple two-page intake form will be provided prior 1st treatment in the office
1. Bio-Mat sessions
2. Far Infrared Sauna-Dome
3. Ionic Foot Bath
Please make sure to bring in your photo Id to your first appointment.
REGARDING: Colon Hydrotherapy:
1. Fill out the online form to the right and then send us a quick email letting us know you filled out the form and it is a request for colonics.
2. Our naturopathic doctor will review your intake form* and make sure receiving colonics is safe for you. This is an annual requirement. You might receive a call to clarify your information if such clarification is necessary.
3. You will then receive a call or email from our office to confirm that you are approved and to schedule your first appointment.
If you choose an outside physician to fill out your approval "prescription" you still must fully complete our forms. Click here for VPG Wave's Blank Prescription Form Here
A valid doctor's prescription pad must include "approval for a full series of colon hydrotherapy services" and "use as needed." (they may add, any additional comments if they choose.)
*VERY IMPORTANT, THE FIRST NOTICE FROM MINDBODY, FOR YOUR 1st APPOINTMENT WITH THE ND, IS NOT AN APPOINTMENT YOU NEED TO COME IN FOR! THIS IS JUST AN APPOINTMENT THE ND WILL HAVE TO REVIEW YOUR INTAKE. PLEASE DO NOT COME IN IF YOU GET AN APPOINTMENT REMINDER FROM MINDBODY OR VITALIZED PERFORMANCE GROUP FOR NATUROPATHIC MEDICINE: ND COLONIC REVIEW. *