Clinic Forms

New Patients of Patricia Hallam, L.Ac.:

Please print out and fill in the Patient Health History Form and Patient Information & Financial Policy Form ahead of time and bring to your first visit (click on the links below to open and print the files):

Patient Health History Form – Women

Patient Health History Form – Men

Patient Information & Financial Policy Form

 

New Patients of Dr. Daivati Bharadvaj, N.D.:

Please print out and fill in these forms ahead of time and bring to your first visit (click on the link below to open and print the files):

New Patient Forms for Dr. Daivati

Also, before your first appointment with Dr. Daivati, please fill out your insurance information using the online form below (coming soon).  Use “Alive & Well Healing Arts” as the healthcare provider name.  And bring your insurance card with you at our first appointment.  Thanks!

https://www.efficientmbs.com/demographics-form/