Patient Forms

New Patients & Existing Patients

New Patients

Please read the information below prior to completing your forms.

  • Please fill out forms in pen, NO PENCIL
  • Please print single sided
  • These forms need to be filled out completely, at least 2 weeks prior to the appointment. Completed forms can be mailed or dropped off at the office. Please DO NOT fax the forms

East-West Integrated Medicine has a 48-business hour cancellation policy. This means Monday appointments need to be cancelled no later than Thursday at 3pm.

New Patient forms

Children under 12 New Patient Forms

Existing Patients