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
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Maximum size 10MB

Form #2 - Acknowledgement

Download Patient Acknowledgement Form - .doc
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Maximum size 10MB

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
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Maximum size 10MB

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