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Patient Forms

New Patient Forms

  1. Medical Intake form
  2. Treatment Form
  3. Medical Authorization Form
  4. Health History Form
  5. HIPAA Notice of Privacy Practices & Acknowledgement Form
  6. Emergency Contact Form

 

 

     

    Current Patient Forms

    1. COVID-19 Daily Health Screening Form
    2. Medical Authorization Form
    3. Health History Form

     

     

       

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      IndiHeartandMind, Inc. (Corporate HQ)

      7800 W Oakland Park Blvd Suite 304
      Sunrise, FL 33351
      (561) 404-1422
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