Integrative Medicine Patient Forms


 

Biomedical Intervention Consultation Forms

Appointment Scheduling Packet

In order to be scheduled for an appointment, we require that you submit these forms:

  1. Patient Registration Form
  2. Financial Policy Agreement - please call for an updated copy

Once we receive this packet, we will contact you to book your appointment.

Initial Consultation Packet

The following forms, as applicable, must be completed at least 7-10 days prior to the scheduled appointment. Please submit these forms promptly in order that time is maximized wisely during the scheduled visit.

  1. ABTC Questionnaire - for Child patients
  2. Exposure History - for Adult patients
  3. Informed Consent and Disclaimer
  4. Notice of Privacy Practices
  5. Adult Medical Questionnaire


Detoxification Program


Verju Laser Forms

To request an appointment, you will need to complete the following forms:

For CURRENT Patients of Dr. Comia:

For NEW Patients, please complete the above forms plus the following:

Your treatment schedule will be arranged during the Physician Consultation visit.


Hyperbaric Oxygen Therapy Forms


Intravenous (IV) Therapy Forms


Religious Exemption Form