Vital Health and Wellness // Contact Us

Forms

Augusta Swift, N.D.

Adult Intake Form: Download Here
Clinic Policy Agreement: Download Here
HIPAA Privacy Form: Download Here

Lee Ann Petrie, N.T.P.

Nutritional Assessment Questionnaire: Download Here

Kevin Colling, D.C.

Patient Introduction Form: Download Here
General Health History: Download Here
Symptom Drawing: Download Here
Informed Consent: Download Here
Personal Injury Introduction Form - Auto Accident: Download Here
Metabolic Assessment: Download Here
Oswestry Back Pain and Disability Questionaire: Download Here

Jill C. Ghormley, N.D., M.A.M.S.

Patient Introduction Form: Download Here
Patient Intake Form: Download Here
Patient Responsibility Form: Download Here
Insurance Questionnaire Form: Download Here

Kathy Sweeney, N.D.

Patient Intake Form: Download Here
Patient Responsibility Form: Download Here
Pediatric Intake Form (Birth - 5 years old): Download Here
Pediatric Intake Form (6 - 12 years old): Download Here

Kirsten Schumaker, LMT

Confidential Health Profile and Client Information: Download Here
Health Insurance Information: Download Here
Insurance Information for MVA Claim: Download Here
HIPAA Form: Download Here
Guidelines for Referrals: Download Here

Tiffany Ueltschi, LMT, Doula

Massage Intake Form: Download Here
Maya Abdominal Massage Intake Form: Download Here

Links

Dr. Colling’s Blog

Health Newsletters

2010

2009