Forms

 

Intake forms:

E-mail [email protected] to get an electronic copy of our intake forms.  At this time we are only accepting new patients who have already completed their intake forms in their entirety. You may request an intake form by e-mailing [email protected]  Make sure to specify which physician you wish to see, and whether it is a visit for your child (well child, or problem-specific) or yourself.

Office policies:

Our office policies are included in your electronic intake form.

Verify insurance:

We are happy to submit a claim to your insurer for you.  Dr. Krumbeck, Dr. Featherman and Dr. Dalili are in-network physicians with many insurance plans.  However, many individual plans specifically exclude naturopathic services.   You are responsible for verifying your insurance benefits, and you will be responsible for paying the portion that your insurance does not cover.

Verify Your Insurance Benefits

Optional forms:

For your convenience, you may fill out these forms if necessary
MWH Release of Records
Patient authorization to release confidential information