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For Primary Care patients, please  complete the following intake forms under Primary Care Patient Intake Forms. Once you set your appointment, print out forms, complete them and bring the forms on the day of your appointment.
Also, bring a list of all your current medications with dosages, your recent medical records, labwork and immunization records from past 2 years to your first appointment.

PRIMARY CARE  PATIENT INTAKE FORMS


PRIMARY CARE FORMS




For clients enrolling in our Wellness & Weight Loss program, please complete the following forms under Wellness and Weight Loss Intake Forms and bring to your appointment (in addition to the new patient intake forms)
Also bring a list of your current medications with dosages and your most recent labwork with you to your first appointment.

WEIGHT LOSS & WELLNESS INTAKE FORMS



WEIGHT LOSS FORMS



For clients enrolling in our Integrative / Holistic Health Programs, please complete the following forms and bring to your appointment (in addition to the new patient intake forms)
Also, bring a list of all your current medications with dosages, your recent medical records, labwork and immunization records from past 2 years to your first appointment.

INTEGRATIVE / HOLISTIC HEALTH INTAKE FORMS

New Patient Registration Form.doc

HIPPA-Privacy Form- PDF.pdf

Financial & Health Services Policy-PDF.pdf

Holistic Health Forms- PDF.pdf



**FOR ESTABLISHED PATIENTS**
 Every 3 , 6 and 12 month time periods in which you are a patient at Eze Family Health Center, we want to monitor how well your overall health has improved. Complete the Health Status  form at the end of your 3rd, 6th and 12th month with us and we will be able to track your health progress over time.

Health Progress Survey- PDF2.pdf



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