INTAKE FORMS

please attach independent appropriate forms (in PDF format) and send to kelly.neil@hadarimc.com

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For assistance in editing the documents to submit back to HIMC, download this free Word Processor & PDF Editor click here  

Please when uploading documents, upload each document individually. This prevents them from becoming too large of a file to upload into our Secured Electronic Record.

 

Privacy Practice Form (No Need to sign and print, for your records)

         Privacy Practice

 

TSM-intake forms

        Telemedicine Consent Form

        HIMC Financial Agreement

        Medical Intake Form

        TSM Intake Questionnaire

LDN / Other -intake forms 

       Telemedicine Consent Form

       HIMC Financial Agreement

       Medical Intake Form

Dear new patients, fill out the appropriate forms in the Intake Form tab and attach to the email in PDF format.

Appointments will be made at the next available opportunity.  

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