Welcome to new patient and client registration! Please download and complete the intake forms and bring them with you to your first appointment.
IMPORTANT INFORMATION TO READ ABOUT REGISTRATION:
- Dr. Garner is not a participating Medicare provider. If you would like to be seen for wellness or maintenance programming ONLY and you are on Medicare, then Dr. G can discuss the parameters for being seen.
- Patient Privacy Disclosure Statement: In filling out the patient registration, I understand that EudeMOMia® will maintain my privacy to the highest standards and may use or disclose my personal health information for the purposes of carrying out treatment, obtaining payment, evaluating the quality of services provided and any administrative operations related to treatment or payment.
New Patient & Client Registration
You CANNOT BE SEEN until the following forms are completed:
- Informed Consent & Policy Agreement
- Intake Registration
- SF-36 – Bring a copy of the results to your first appointment or take a screenshot so we can see the scores.
- Telehealth Consent – FOR TELEHEALTH ONLY
- Medicare Non-Provider Agreement – FOR MEDICARE ONLY
- Dry Needling Consent – IF YOU THINK DRY NEEDLING MAY BE RIGHT FOR YOU
Medical Record Release Form
If you need to share your medical records from Dr. Garner’s office with another provider, this form must be completed.
For Ayurvedic Consults Only
If any of these forms are needed Dr. Garner will have you complete them at a later date.
