Get Alliance Wellness Intake And Consent Form - Stellarhealth

Completing the Alliance Wellness Intake And Consent Form is an essential step towards receiving comprehensive care. This guide provides clear instructions for each section of the form to ensure you accurately share important information regarding your health.

Follow the steps to fill out your intake and consent form effectively.

1. Use the ‘Get Form’ button to access the intake and consent form online. This action will open the document for you to start filling out.
2. Begin by entering your personal information. Fill in your full name including first, middle, and last names, along with your preferred name if different. Add your age, gender, weight, date of birth, height, marital status, and number of children.
3. Provide your contact details, including your home address, phone numbers (home, work, cell), and email address for sending handouts. Indicate whether you would like to receive newsletters via email.
4. Identify an emergency contact by listing their name and contact information. Additionally, share how you found out about the clinic and if you were referred by someone.
5. Outline your health concerns in order of importance, detailing the goals you wish to achieve for each concern. Add any relevant notes to better inform your practitioner.
6. In the health/lifestyle section, evaluate your health status and indicate whether you exercise regularly, including details on type, frequency, and any impediments to your activity.
7. Complete the medical history section by listing past conditions, family health history, current medications, and any known allergies or dietary restrictions.
8. Fill out the immunizations and screening tests you have received, along with the corresponding dates and results.
9. Assess your energy levels, stress levels, and how you manage stress. Provide additional notes if necessary.
10. Review your filled-out form for accuracy. Once completed, save your changes. You may also choose to download, print, or share the form as needed.

Take the next step in your wellness journey by completing your Alliance Wellness Intake And Consent Form online today.