Download Forms

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

Prior to your initial visit, we request that you complete the intake form (Adult or Pediatric, as appropriate) and other required new patient forms (Consent to Treatment, HIPPA Notification and Payment Agreement) and return to us a minimum of 24 hours prior to the visit.  You can either fill out electronically via the patient portal (call to inquire when scheduling) or download from the links at the bottom of this page and print out and fill out by hand and then scan and return to us via fax or email. Our fax number is 805-258-5132 and our email address is info@equinoxnatmed.com.

If you have had any recent labs or imaging done in the last 6-12 months and you have access to these documents, please provide us with a copy.  If you do not have these documents, you can have them sent from your doctor by downloading the records release form and returning the completed and signed form to us.  Although helpful in assessing your case, 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