Before your first visit, you can save time by filling out the appropriate forms.

NATUROPATHIC MEDICINE – NICOLA DEHLINGER, ND

 

LOCAL PATIENT FORMS

Confidential Health Questionnaire

Notice of Privacy Practice

Acknowledgment of Privacy Practices

Patient Consent Form

Financial Policy

Disclosure Statement

Authorization for Credit Card

Authorization to Share Information (Optional)

NON-LOCAL PATIENT FORMS

Confidential Health Questionnaire

Notice of Privacy Practice

Acknowledgment of Privacy Practices

Patient Consent Form

Financial Policy

Disclosure Statement

Authorization for Credit Card

Authorization to Share Information (Optional)

 

**FOR FEES PLEASE REFER TO THE FINANCIAL POLICY**

Dr. Nicola does not accept insurance; however, she can provide a coded super bill at the time of service. Reimbursement depends on your insurance policy.

ACUPUNCTURE & CHINESE MEDICINE – RIKKI GENSHEER L.AC.

FEES

Intake Consultation and Treatment, 1.5 hours – $150

Follow-up Treatments, 75 minutes – $119

Follow-up Treatments, 50 minutes – $95

Herb Consult – $50

Cost of Herbs – $45

 FORMS

Confidential Health Questionnaire

Notice of Privacy Practices

Acknowledgment of Privacy Practices

Patient Consent Form

Informed Consent for Acupuncture Treatment

Disclosure Statement

THERAPY & YOGA – SHELLEY NIELSEN, LCSW & RYT200

FORMS

Disclosure and Responsibilities

New Patient Intake

Authorization for Release of Information

Consent for Online/Telehealth Therapy

MARIE SOLIEL, LBT, CMT, CYT

MASSAGE THERAPY FEES

30 Min $50

60 Min $90

90 Min $130

 FORM

New Patient Intake Form

JENNIFER ROE, ENERGY HEALER ADVISER

FEES

Remote Healing – $100

Red Hat Qigong, 1.5hrs – $200

Akashic Record Reading, 1.5hrs – $200

Health & Wellness Coaching – PLEASE CALL OFFICE FOR PRICING

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