Forms

You may print out the forms below and bring them to the office OR Fill out the info below, print, sign, scan and attach below. You can also send all forms to office@thcevaluation.com


  • Form #1 - Medical History

    Download Patients Medical History/Records Form
  • Form #2 - Acknowledgement

    Download Patient Acknowledgement Form - .doc
  • Form #3 - Medical Release

    Medical Release Form from your doctor. If you already have your medical records, then you do not need the Medical Release.

    Download Holistic Center Medical Release Form IF YOU CAN'T GET YOUR MEDICAL RECORDS IN A REASONABLE TIME JUST HAVE YOUR CARE PROVIDER FILL OUT THIS FORM AND SEND IT TO: office@thcevaluation.com or FAX 617-419-1051


If you have trouble attaching the completed files to this form, please email them to: office@thcevaluation.com

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