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Forms and Documents

New Patient Forms


General Registration
New patients (including pediatrics)

Adult Medical History
New adult patients (except for women new to hormone/menopausal care with Connie, please complete form below instead)

Pediatric Health History
New pediatric patients

Hormone/Menopausal History Form
For patients new to Connie Ryan, WHNP

Headache History Form
For Patients of Dr. Pugh

In-Depth History Form
For New Patients of Dr. Pugh

Genetic Consult Form

Portal Consent Form
For All New Patients

 

Alpha listing by specialty


Acupuncture Consent
New acupuncture patients

Acupuncture Health History
New acupuncture patients

Acupuncture Privacy and Payment Policy
New acupuncture patients

Genetic Consult Form 

Ideal Protein Health Profile
To determine a client’s health status in order to guide the IP weight loss plan.

Medical Records IN
Medical records IN from other providers to CFP

Medical Records OUT
Medical records to be sent OUT to other providers from CFP

Reproductive Health History
New patients for Fertility and Reproductive Health

Sports PE Form
For 2016-2017

Vascular Health Consent
Patients with Vascular Health Screening appointment

Vascular Screening Information
Information about Vascular Health Screening