PATIENT FORMS

New Patients

“Listen to the patient. He will tell you what’s wrong with him.” ~Sir William Osler

According to research 35%-56% more information in histories is gathered by using forms. This leads to improved communication, and a quicker diagnosis. Before we can decide if our clinic can provide the care you need, our providers need to review your case.

Please call the front desk to acquire the “New Patient Application.” (We apologize for the paperwork, but this saves us time during your visit; it’s the most efficient way to get the detailed information we need to make a correct assessment and design an effective individualized treatment program for you.)

Upon completing the forms, notify the New Patient Coordinator. From there, our providers will review your case to determine if a symbiotic relationship is feasible; the New Patient Coordinator will call to schedule your first appointment if it is.

At your first appointment, please, come in 15-20 minutes early. Bring your insurance card(s), and any pertinent test results or reports from imaging studies. Please, have your history forms already completed and, please, bring in your medications and any supplements you may be taking.

If you are coming in or considering acupuncture it is highly recommended you fill out and print this questionnaire. Treatment is often based on the patient’s constitutional tendencies, or biopsychotypes, that influence their life and health. To learn more about your biopsychotype, visit Dr. Joe Helms’ “Learning More About You”questionnaire and bring to your acupuncture appointment.

If you are coming in for a pediatric well child check, please print off and fill out the Ages and Stages Questionnaire for the appropriate age.

If you would like us to request a copy of your medical records from another medical office please fill out the medical release and either drop by, mail, fax, or email a signed copy.

Authorization to Release Medical Information

Notice of Privacy Practices

Consent for Treatment

Preferred Method of Communication

Office Financial Policy

Getting the most out of your first visit

Your first visit is very important, as it is during this visit that lays the framework to helping you reestablish your health. The more complete picture we have of yoVideour life and health history the better we can serve you.

You can only see the future if you know where you came. The key to restoring health is knowing what set you up for your current issues, what were the triggering events, and what are the mediators that keep you from healing. If we can establish a health timeline we can connect the dots and hopefully unravel the mystery of why you feel the way you do.

Sample Antecedents, Trigger s, and Mediators

Blank Timeline

Acupuncture and General Follow up Visits

If you are coming in or considering acupuncture it is highly recommended you fill out and print this questionaire for your initial treatment. Treatment is often based on the patient’s constitutional tendencies, or biopsychotypes, that influence their life and health. To learn more about your biopsychotype, visit Dr. Joe Helms’ “Learning More About You” questionnaire and bring to your acupuncture appointment.

It is recommended you fill out the MSQ at least every 2-3 months to help track your progress, especially if your initial score was greater than 50.

MSQ – Medical Symptom/Toxicity Questionnaire

Well Child Visits

Please contact the office to be sent the Ages and Stages Questionnaires for well child visits.

Lab Results and Patient Portal

You are able to access your lab results/imaging studies on the patient portal as soon as the results become available. You are also able to send secure messages to the office and download your medical records and review your recent visit plans.

Request access to Elation Passport now.