Patient Forms
Documents listed with a * below are password protected. If you are a patient at LTP Natural Medical Center please call the office to obtain the password.
| Document Name | Description | File Size |
|---|
| *New Patient Intake (click to download) |
This packet must be completed and sent to LTP Natural Medical Center prior to your initial intake. The other forms below are not required unless specifically requested. |
850KB |
| *New Pediatric Patient Intake |
This packet must be completed and sent to LTP Natural Medical Center prior to your childs initial intake. The other forms below are not required unless specifically requested. |
770KB |
| *Weight Loss Intake Form |
Prior to starting the weight loss program at LTP Natural Medical Center you must complete this form and either bring it with you for your initial appointment or you can fax or mail it to us prior to your appointment. |
2.0MB |
| *Medical Record Release |
This form can help if you need to request prior medical records (labs, patient history, etc.) be sent to LTP Natural Medical Center from another physician or hospital. |
19KB |
| *SSIBD Questionnaire |
Sickness Syndrome Inflamed Brain Depression Questionnaire |
21KB |
| *B12 Reporting Form |
Form for reporting the effects of B12 injections. |
388KB |