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W Clinic of Integrative Medicine

We utilize integrative and natural therapies to enable you to take an active stance in your health

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    • Naturopathic Medicine
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    • Bioidentical Hormone Replacement Therapy
    • Testosterone Replacement for Men
    • Allergies & Asthma: Sublingual Immunotherapy (SLIT)
    • Acupuncture
    • Natural Pain Management
  • PRP Therapies
    • Prolotherapy
    • Natural Treatment for Hair Loss
  • Medical Weight Loss
    • HCG Diet
    • Phentermine
    • Topiramate + Phentermine
    • B12/MIC Shots
    • Injection Special
  • Patient Paperwork
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Patient Paperwork

Below is the New Patient Paperwork. Please, click on each file below to download it. 

Note: The HIPAA Privacy Policy is available for your information and does not need to be signed or returned.

Female-Intake-Forms_WClinic_CCWay_2021_Updated

Male-Intake-Forms_WClinic_CCWay_2021_Updated

Pediatric-Intake-Forms_WCLINIC_CCWay_2021_Updated

HIPAA Privacy Policy_UpdatedOctober2014

Please Note there is a Required 24 Hour Cancellation Notice for any canceled appointments. Appointments canceled with less than 24 hours notice or not at all (a no-show will be subject to a late cancel fee.

New Patient Appointments canceled with less than a 24 hour notice or a No show/Missed New Patient Appointment will result in us having to take a credit card number on file in order to reschedule your appointment.

If you are using Health Insurance for your visit (or you have new/different Health Insurance for your visit), please provide us with your insurance information (Insurance Company name, ID, Group #, Plan, and/or a copy of insurance card) 24 hours or more prior to your appointment date. This ensures that your insurance is verified ahead of time, allowing for the full scheduled time for your appointment with the doctor. If we do not receive your health insurance information ahead of time, we have the right to reschedule your appointment to a later date. 

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