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Blue Mountains
Blue Mountains

Helpful Forms

 

Directions To Office Directions to Office 
Adult Intake To PRINT OFF and Fill Out with a PEN Adult New Intake To Print Off and Fill Out with a Pen (DO NOT Fill Out Online)
Adult Intake To Fill Out ONLINE Only Adult New Intake To Fill Out ONLINE Only
Child Intake To Print & Fill Out with Pen Child New Intake To Print Off and Fill Out with a Pen (DO NOT Fill Out Online) 
Child Intake To Fill Out ONLINE Only Child ONLINE Only  New Intake to Fill Out
HIPPA Notification HIPPA Notifications
State of Nevada Employee Form State of Nevada Form To Sign
Financial Agreement for Credit Card Use Financial Agreement for Credit Card Use

 

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We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

Please don't put anything here:
Please enter the words below: Click to reload image What is this?


By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.

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Helpful Forms

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