New Patient Forms | Boutique Wellness NC Registration

ATTACHED FORMS:

Horowitz Lyme-MSIDS Questionnaire (PDF)

Fasting Primer Instructions (PDF)

Informed Consent For Consultation (PDF)

Low Mold Diet Instructions (PDF)

Consent for Injectable Treatment (PDF)

Consent Nucleoskin Topic (PDF)

Informed Consent for Consultation (PDF)

Consent PRP (PDF)

Health History (PDF)

Electronic Communications Agreement (PDF)

Consent for Treatment with PDO (Polydioxone) Suture Threads (PDF)

Consent for Undergoing Activated Oxygen Therapies with UBI Therapy (PDF)

Authorize to use or Disclose (Release) Health Information that Identifies you for a Research Study (PDF)

Electronic Communications Agreement (PDF)

Informed Consent for Consultation (PDF)

Cellenis Derma PRP Informed Consent (PDF)

Written Acknowledgment of Privacy Practices (PDF)

Informed Consent for Peptide Therapy (PDF)

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