All patients must read and return a signed copy of the Good Life Medicine Center HIPAA Privacy Disclosure Form by email, by fax, or at your in-office appointment.  If you have any questions, please feel free to ask your practitioner. 

 

Practitioners Listed Alphabetically by Last Name

Burke, Emily

Patients being seen in office:

Please review our HIPAA Privacy Disclosure , then fill out Dr. Burke's  intake form and Financial Policy. Fax or email it to the office, or bring it with you to your appointment.

If you have scheduled a remote educational consult via phone or Skype:

Please fill out our remote consultation disclaimer form and Dr. Burke's  intake form. You MUST fax or email a signed copy to the office before your appointment.

Here is our Release of Information Form

 

Davis, Mark

Patients being seen in office:

Please review our HIPAA Privacy Disclosure, then fill out Dr. Davis' intake form and Financial Policy. Fax or email it to the office, or bring it with you to your appointment.

If you have scheduled a remote educational consult via phone or Skype:

Please fill out our remote consultation disclaimer form and Dr. Davis' intake form. You MUST fax or email a signed copy to the office before your appointment.

Here is our Release of Information Form 

 

Lane, Andrea

Patient Health History

HIPAA compliance

Informed Consent to Treat

Payment & Cancellation

 

Parramore, Karin

Karin Parramore, LAc, CH: please fill out a copy of the acupuncture intake form OR the facial treatment intake form, AND both the informed consent and HIPAA consent forms and bring them to your first appointment. Please contact the front desk and plan to arrive about 15 minutes early if you would prefer to fill out the forms in office. 

 

Touchet, Ariel

Ariel Touchet, ND: Please read the New Patient Welcome letter and the Statement of Financial Responsibility.  Please read and sign the Patient HIPAA Consent Form and one or both of the Consent to Naturopathic Treatment and Consent to Acupuncture Treatment.  Please fill out a copy of the  Patient Information form (if the patient is less than 18 years old, please fill out a Pediatric Intake Form instead) and return your signed forms one week prior to your appointment by e-mail, fax, mail, or drop them off at Good Life Medicine Center for Dr. Touchet to review.