Download Forms

Please set aside adequate time in advance of your appointment to complete the new patient forms and bring copies of all forms to your appointment.  The intake form is extensive and should be thoughtfully completed.  The time spent on completing this paperwork is a critical investment in your health.

Please have all of your paperwork completely filled out when you arrive for your appointment.  This includes the Intake Form (Adult or Pediatric, as appropriate) and the Other Required New Patient Forms (Consent to Treatment, HIPPA Notification and Payment Agreement).  If you have not completed the paperwork, any time you take completing it will cut into your scheduled appointment time.  Thank you for your cooperation and understanding.

To optimize your initial visit, we request that you fax (805-258-5132), mail (a copy), scan and email (info@equinoxnatmed.com), or drop off your Intake Form a minimum of 24 hours prior to your first visit (if mailing, please mail several days in advance).  This will allow the doctor to study your chart in advance allowing for a productive and efficient initial visit.  It is not necessary to provide the Other Required New Patient Forms in advance (Consent to Treatment, HIPPA Notification or Payment Agreement forms).  However, please bring hard copies of all completed forms to your first visit.

Also, please bring any pertinent medical records you have including recent labs or imaging reports.  If you do not have these, you can have them sent from your other doctor(s) by downloading and completing the records release form and providing them with a signed copy of this form. Please note that we do NOT need to have your previous medical records prior to your initial visit.

NEW PATIENT FORMS:

ADULT INTAKE FORM

OTHER REQUIRED NEW PATIENT FORMS

PEDIATRIC INTAKE FORM (0-5 YEARS)

PEDIATRIC INTAKE FORM (6-12 YEARS)

RELEASE OF RECORDS:

RELEASE OF RECORDS TO EQUINOX FORM