🗂️ Patient Forms

For all new patients joining Entirety Healthcare.
This form helps us gather your medical history, current medications, allergies, and health goals — so our team can personalize your care plan.

Includes:

• Contact & demographic information 
• Medical history & current conditions 
• Medication & allergy list 
• Emergency contact 
• Consent for treatment 

🖋️ [Download New Patient Intake Form (PDF)]
💻 [Submit Securely Online] (Patient's portal)

If you’re meeting your provider virtually, please complete this consent form.
It ensures you understand how telemedicine works, your privacy rights, and the security measures we take to protect your health information.

Includes:

• Explanation of telehealth process
• Patient rights under HIPAA
• Informed consent for virtual care 
• Technology and confidentiality agreement 

🖋️ [Download Telemedicine Consent Form (PDF)]

 We’re honored to walk with you on your personal growth and wellness journey.
Please complete this confidential form before your first session. The information you provide helps us tailor your coaching experience to your specific needs and goals. 

🖋️ [Download Telemedicine Consent Form (PDF)]

Before receiving any wellness or cosmetic treatment (IV therapy, injections, facials, etc.), this form confirms you understand the nature of the procedure, expected results, and aftercare.

Includes:

• Treatment consent and acknowledgment
• Contraindication checklist
• Pre- and post-treatment care guidelines

🖋️ [Download Aesthetic Treatment Consent Form (PDF)]

For patients enrolled in our medically supervised weight management or wellness programs.
This form outlines expectations, monitoring schedule, and your customized wellness goals.

Includes:

• Lifestyle & nutrition questionnaire
• Progress tracking authorization 
• Provider-patient commitment to success 

🖋️ [Download Weight Management Agreement (PDF)]

Use this form if you need Entirety Healthcare to share or receive medical information from another provider, facility, or specialist.

🖋️ [Download Medical Records Release Form (PDF)]

 You may return completed forms in one of the following ways:

• Upload to our secure patient portal (recommended for privacy) 
• Email encrypted copies to: [forms@entiretyhealthcare.com
• Fax: [Insert fax number]
• In person at the time of your appointment

If you need help completing or accessing a form, our friendly staff is happy to assist you.
Simply call or email us — we’ll guide you through it step-by-step.

📞 [Insert clinic phone number]
📧 [info@entiretyhealthcare.com]
🌐 www.entiretyhealthcare.com

Entirety Healthcare
Integrated Healthcare & Wellness Center
“Healing the whole — mind, body, and being.”