Get Nardella Hyperbaric Oxygen Therapy Intake Form

Completing the Nardella Hyperbaric Oxygen Therapy Intake Form online is a straightforward process designed to gather essential information for your therapy. This guide will walk you through each section of the form, ensuring you understand what is required for a smooth intake experience.

Follow the steps to successfully complete the intake form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling in your personal information. Provide your name, age, birth date, and contact details, including your home, work, and cell phone numbers. Ensure your email address is accurate for communication purposes.
3. Next, complete the 'Family Physician' section by providing the name and contact information of your physician. This helps in coordinating care effectively.
4. In case of emergency, provide the contact information for someone who can be reached. Include their address and relationship to you.
5. Indicate how you heard about the clinic and whether you have seen a naturopathic doctor before. If you have, specify the reasons for your previous visits.
6. Moving on to the 'Current Health History' section, describe your primary health concern, how long you have had this condition, and any activities that may aggravate it.
7. List any other health concerns you have and detail any known allergies, including medications and food.
8. Indicate if you have ever experienced any mental or emotional disorders and state any other therapies you are currently engaging in.
9. In the 'Medication and Supplement History' section, document all medications, supplements, and dosages you are currently taking. Include the reason for each medication.
10. Provide details about any history of antibiotic use over the past two years, including dates, duration, and conditions treated.
11. In the 'Health History' section, indicate the conditions you seek treatment for by checking the appropriate boxes.
12. Specify any past medical history, surgeries, or serious injuries, along with their dates and complications if applicable.
13. Complete the 'Family Health History' section by outlining any relevant health conditions of your blood relatives.
14. Review the informed consent statement, confirming your understanding of the clinic's approach to treatment. Provide your printed name, signature, and date to acknowledge receipt.
15. Once the form is completely filled out, ensure all sections are double-checked for accuracy. You can then choose to save changes, download, print, or share the form as needed.

Complete your Nardella Hyperbaric Oxygen Therapy Intake Form online today for prompt and efficient processing.