Get Quantum Biofeedback Intake Form Agreement - Downloads Imune

Completing the Quantum Biofeedback Intake Form Agreement is a crucial step in utilizing biofeedback therapies effectively. This guide will assist you in understanding each section of the form and provide clear instructions for filling it out online.

Follow the steps to successfully complete the intake form.

1. Press the ‘Get Form’ button to acquire the form and open it in the designated editor.
2. Begin by entering your name or the name of the patient you are representing. Write down the address, email, phone number, birthday, birthplace, and today’s date.
3. In the referral section, indicate your choice about medical supervision by circling the appropriate letter (a, b, or c). If you choose option a, provide your primary care doctor's name, clinic name, and contact details.
4. For option a, indicate whether you give permission to share your medical records by checking 'Yes' or 'No.' If you select option b, write down the names of the doctors you wish to be referred to.
5. If you choose option c, indicate your understanding that you do not want any additional medical supervision.
6. Detail your past medical history, including diagnoses, treatments, surgeries, and any other relevant medical information in the space provided.
7. Review the confidentiality clause and applicable law information to ensure you understand your rights and the rules governing the agreement.
8. Complete the section regarding mutual understanding, sign the document, and include the date. The intake therapist will also sign and date the form.
9. Once all fields are completed, save your changes, then choose to download, print, or share the form as needed.

Complete your Quantum Biofeedback Intake Form Agreement online today!