Patient Information
Download Patient Forms
To view the forms listed below, you will need to download Adobe Reader.
In order to make our initial consultation most effective and efficient, the forms to the right will be sent to you using the Luminello Patient portal. It is a HIPAA compliant method to deliver patient information securely.
- Please look for an email invitation from Luminello.
- Once an account with Luminello is created, you will be able to find the electronic version of all the needed documents, so you can fill them out and submit to our clinic’s review without the need to print, scan or use of special software.
Consultation appointments may be cancelled if the intake paperwork in its entirety is not submitted within 48 hours of an initial consultation without discussing it with the clinic in advance.
Please note that in addition to the initial New Patient paperwork, as stated above, you must review, and consent to the financial agreement and Credit Card Authorization forms.
The financial credit card authorization forms and payment information is sent from the following email address: noreply@messaging.squareup.com
- The subject line is “Contract #”…
- You can copy and search your mail for this address and/or subject. It may be in your junk mail.