Thank you for visiting our forms section. Below you will find links to help you get started. If you have any questions, please contact us. To expedite your first appointment please complete the following:
- Download and READ our HIPPA form. You do not need to print these forms, but will be asked to sign in the New patient intake form that you have read and agree to these agreements. If you have any questions regarding these forms, please do not hesitate to ask.
- Download and COMPLETE the New Patient Intake Form and Blood Work Form. After completing the forms, if possible, please FAX it to 623-249-4748 a few days prior to your scheduled visit. If faxing is not an option, please BRING the completed copy to your first appointment. Allow at least 30 minutes to complete the paperwork.
- BRING in copies of all recent LAB WORK on the day of your visit or FAX your completed Record Release Authorization to Dr. Jen’s Office 623-249-4748 prior to your visit. We will request copies of your lab work for you prior to your visit. Having recent labs allows for a more effective first visit.
- New Patient Intake Form
- Blood Work Form
- Hormone Checklist
- Financial Policy
- Records Release Form to Dr. Jen
- Records Release Form from Dr. Jen
- Medicare Waiver Form
- Homeopathic Intake Form
- Na2EDTA or CaEDTA Chelation Therapy
- Intravenous Nutrient Therapy
- Appealing a Denied Insurance Claim
- How to Get Insurance Reimbursement