Wellness, Naturally

​​​​​​​​Dr. Lisa Smith, ND

Forms

Below are links to the adult (13+ years of age) and child (0-12 years of age) intake forms. The respective form should be completed prior to the start of your initial consultation to avoid delays in starting the intake process. This intake form will provide a baseline of information that will start our conversation for each concern to be further explored. If you choose, you can print the appropriate form and complete it ahead of time, or you can arrive to the clinic 15-minutes prior to the start of your visit to complete it there.

The consent forms are also available for your review below, however I ask that you only review these prior to your first visit and reserve signing them until we have discussed their content and I have answered any questions you may have.

Adult Intake Form: please complete all 4 pages of this form prior to your first visit if you are 13 years of age or older.

Child Intake Form: please complete all pages of this form prior to your child’s first visit if your child is under 13 years of age.

Informed Consent Form: please review the content of this form prior to your first visit. We will both sign the form once we have discussed it’s content.

Privacy Policy Consent Form: please review the content of this form prior to your first visit, to be signed at your first visit.

Clinic Cancellation Policy: please review the content of this form prior to your first visit. We will both sign the form once we have discussed it’s content.

Email Communication Consent Form: if you choose to communicate with me or the clinic via email, please review the content of this form prior to your first visit, to be signed at your first visit.