NEW PATIENT

Clinic Forms

Prior to your first visit to KSK Integrative Medicine, we highly recommend that you print out the forms below (click on the PDF logo for the respective document) and fill them out thoroughly, with as much detail as possible, before you arrive for your initial appointment. (If you're unsure about anything, you may leave it blank and discuss with Dr. Kim at your appointment.)

 

By completing these forms prior to your initial visit, this will help expedite the check-in progress, and allow Dr. Kim to have more time to personally review your medical history with you, and begin your treatment in a timely manner.

If you are unable to print out the documents prior to your first appointment, no problem. Please plan to arrive at least 15-20 minutes before your scheduled appointment time to complete these required documents.  

 

Should you have any questions, please feel free to call (949) 424-7883. Thank you!

01

New Patient Health History Questionnaire

02

Informed Consent

Agreement

03

HIPAA Notice of Privacy Practices/ Signature Page

04

MYMOP

Form

05

Late/ Cancellation Policy Signature Page

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