NEW PATIENT FORMS

 

Your intake form is one of the most important aspects of your program. Please take your time carefully filling out the form and follow the instructions below carefully:

Both the Intake Form and Consent Form must be filled out and saved in Adobe or printed and filled out manually. DO NOT fill it out in your browser.

Take your time telling your story. The more we know, the better we can help. If you are not sure how to answer, leave a question mark next to the question.

Please fill this paperwork out completely. Do not leave any section blank. This paperwork is part of your exam. If the paperwork is not completely filled out at the time of your appointment you will have to reschedule.

You may send the filled out form to info@drcrifase.com once completed or bring it to your consultation.

Please click on the red buttons below to download the forms.

Please fill this paperwork out completely. Do not leave any section blank. This paperwork is part of your exam. If the paperwork is not completely filled out at the time of your appointment you will have to reschedule.

Please be on time for your scheduled appointment.

Thank you for your understanding and cooperation.

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The information on this site is solely for purposes of general patient education, and may not be relied upon as a substitute for professional medical care. Consult your own physician for evaluation and treatment of your specific condition. 

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