IMPT New Client Form For your first visit

These are the forms for new patients. Please fill out all four pages, and feel free to write on the backside if you need more room. Please bring copies of any tests like MRI, X-rays, CT scans, surgical reports, etc.

IMPTAZ NEW CLIENT FORM (pdf)

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IMPT SELF-PROGRESS NOTE (for current clients only)

These are forms for current patients to be updated annually or when there are any medical condition changes.

IMPTAZ SELF-PROGRESS NOTE (pdf)

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HIPPA PRIVACY/DISCLOSURE - PLEASE READ Before first visit

HIPAA PRIVACY/DISCLOSURE (pdf)

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