We appreciate you taking the time to review the forms and information needed for your visit at Integrative Medical Clinic. We are here to serve your health care needs. If you have questions or difficulties, please use the contact us button.
For your first appointment with a new provider at IMC we recommend completing your forms BEFORE you come to the clinic. This will give you more time with your provider.
New patient forms for physician appointments will take about 30 minutes. All new patients to the clinic need to complete the Patient Registration form. For appointments with Drs. Dozor, Barnett, or Nichols please also complete the Health History form. For forms completed on line, we accept typed signatures.
Forms can be completed on line or printed out and completed by hand. Be sure to save a copy of your completed form for your files.
The Steps to Complete Your Forms:
- Check the list below for the appropriate form.
- Click on the form you need to complete and a PDF file will open on the screen, or you will be asked to be download it to your computer.
- PRINT the form and complete it in writing. Some of the PDF files are able to be filled out using your computer. Just click each field and type your information. You can then save the completed PDF form to your computer.
- Print a copy for your files.
List of IMC Forms:
- Patient Registration
- Health History – Drs Dozor, Barnett
- Chiropractic Intake 1 (1 of 2)
- Chiropractic Intake 2 (2 of 2)
- Dr Moses Goldberg Naturopathic Intake – (Adult)
- Dr Dana Michaeles Naturopathic Intake – (Adult)
- Naturopathic Intake – (Child)
- Auto Accident Form
- ABC Membership Agreement
- Care Conference Personal Health Survey
- Medicare ABN
- Patient Records Request
Choose One of the Following 3 Options for Getting the Form to IMC:
- Send IMC an email and attach the completed PDF form from your computer. Or –
- Print out the completed form and fax it to IMC at (707) 284-9204. Or –
- Print out the completed form and bring or mail it to IMC for your appointment.