Pure Wellness Centers


New Patient Intake

Please download both of these PDF forms, print, fill them out and bring them to your first appointment. It can take one to two hours to complete these forms. Please give them your full attention as your answers are an important part of measuring your health status and finding solutions. You will get out of these questions what you put into them. They will seem redundant, but they relate to different processes and systems in your body.

Thank you for your help.

Pure Wellness Intake

Registration and Health History

Questionnaire

Holistic Clinical Approaches

Note: To download Adobe Acrobat Reader for free, click here.

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