Intake Forms

Please print and complete the forms below for your first appointment,
or arrive 20 minutes prior to your scheduled time to complete them at our office.

 

All Patients

Intake and HIPAA Forms to Print

General Pain Scale

These forms are for specific concerns:

Designation of Personal Representative

Horowitz Lyme Questionnaire

Everyday Memory Questionnaire

Crohns-Disease-Activity-Index

Headache Disabilty Index

Symptom Impact Questionnaire

Fibromylagia Impact Questionnaire (FIQR)

Our physician will meet with you to review your health history, medical conditions and medications and prescribe HBOT if is appropriate for your situation, or your physician may provide a prescription for you.