Harmonizing Body & Mind
Harmonizing Body & Mind
 

Forms & Documents

Initial Client Health History 05-30-13
Please complete and bring to your first scheduled session. Thank you.
EST Client Health History 053013.pdf
Adobe Acrobat document [73.3 KB]
Minor-Guardian Consent & Health History Form
Minor-Guardian Consent & Health History Form
EST Guardian-Minor Constent Client Heal[...]
Adobe Acrobat document [73.8 KB]
Client Rights 053013
EST Client Rights 053013.pdf
Adobe Acrobat document [68.6 KB]
Client Responsibilities 053013
EST Client Responsibilities 053013.pdf
Adobe Acrobat document [71.7 KB]
Policies, Terms & Conditions
Eastern Sun Therapeutics Policies, Terms & Conditions
Policies 111519.pdf
Adobe Acrobat document [277.2 KB]
HIPAA Consent To Release PHI 053013
You must complete this form, in its entirety for us to release any protected health information. If you have questions or concerns on how to complete the form, please contact us Phone (303) 324-9742.
EST HIPAA Consent to Release PHI 053013.[...]
Adobe Acrobat document [69.9 KB]
Physician Approval Form for Treatment
Physician Approval Form Required for Individuals with certain physical or mental illnesses, prior to treatment.
physician_permission.pdf
Adobe Acrobat document [70.9 KB]
Physcian Referral Form
If you have been prescribed treatment by your physician, please have your physician complete and return this form prior to your first visit. Thank you.
physician_referral.pdf
Adobe Acrobat document [102.9 KB]
Service Agreement
General Service Agreement for Corporate Wellness and Event/Promotional Massage Services
061613 EST Service Agreement.pdf
Adobe Acrobat document [177.1 KB]

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