Please ensure all paperwork is filled out 24 hours prior to your appointment. If this paperwork is not complete prior to the time of your appointment, we will need to reschedule your appointment. This will help ensure that all patients stay on schedule.

    Acupuncture Patients 

    (Please fill out ALL 3 forms below)

    • Acupuncture (Female) – Please print off, fill out and bring with you on the day of your appointment.
    • Acupuncture (Male) – Please print off, fill out and bring with you on the day of your appointment.
    • Patient Privacy – Click this link, fill out the form and submit online; do not print off.
    • Patient Release Form – Click this link, fill out the form and submit online; do not print off.

      Chiropractic Patients 

      (Please fill out ALL 3 forms below)

      • Patient Privacy – Click this link, fill out the form and submit online; do not print off.
      • Patient QuestionnairePlease print off, fill out and bring with you on the day of your appointment.
      • Patient Release Form – Click this link, fill out the form and submit online; do not print off.

      Kinesio Taping Patients

      (Please fill out BOTH forms below)

      • Patient Privacy – Click this link, fill out the form and submit online; do not print off.
      • Patient Release Form – Click this link, fill out the form and submit online; do not print off.

       

      Nutrition Patients 

      (Please fill out ALL 3 forms below)

      Patient Symptom SurveyOur staff will be sending you an email containing a link to your own unique Patient Symptom Survey for you to complete.

      • Patient Privacy – Click this link, fill out the form and submit online; do not print off.
      • Patient QuestionnaireClick this link, fill out the form and submit online; do not print off.
      • Patient Release Form – Click this link, fill out the form and submit online; do not print off.

      PEMF Therapy Patients

      (Please fill out ALL 3 forms below)

      • Patient Privacy – Click this link, fill out the form and submit online; do not print off.
      • Patient Questionnaire – Click this link, fill out the form and submit online; do not print off.
      • Patient Release Form – Click this link, fill out the form and submit online; do not print off.
      • PEMF Questionnaire – Please print off, fill out and bring with you on the day of your appointment.

        Thermography Patients 

        (if *NEW PATIENT* Please fill out all 5 forms below, if *RETURNING PATIENT* Please fill out the last 2 forms only)

        Breast Thermography

        If you made an appointment for a  full or half body scan or a full or half body scan plus breasts, please see the next section.

        Half Body scans; Half Body + Breast scans; Full Body scan; Full Body + Breast scan

        (If *NEW PATIENT* Please fill out ALL 5 forms below, if *RETURNING PATIENT* Please fill out the last 2 forms only)

        Release of Medical Records

        If you are a current patient and need personal health information sent to an outside provider, please fill out the form below.

        • Release of Medical Records form – Releasing Take2 medical information to another provider or office. Click this link, fill out the form and submit online; do not print off.