Welcome! Thank you for trusting Avena Integrative Medical Center with your health care needs. You just took the first step in your journey towards health. We understand that the care we provide is different than what most patients are used to. To help make your experience a positive one, and to help make your first visit as productive as possible, we required you to complete the following forms before scheduling your first visit:
This form is absolutely critical because it details your health background and history. Since we are a integrative practice, this form is very extensive; completing it before you arrive for your first appointment is essential.
Pediatric Intake Form
Bringing your children to see us? If so, please fill out this intake form specific to patients who are under 13 years of age. If you are over 13, skip this form.
Registration Packet
This registration packet tells us your contact information and contains a number of legal agreements. It contains your consent for us to treat you, notifies you of our financial policies, and includes your acknowledgment that we have provided you with a copy of our Notice of Privacy Practices.
Notice of Privacy Practices
Our Notice of Privacy Practices details our HIPAA compliance regarding how we will and will not use your personal information. There is nothing to sign in this document. We make it available online only for your convenience. You can also get a print copy of it in our offices.
Having trouble viewing these forms? You need a program that will open PDF files. Adobe Acrobat Reader is free. If you still have trouble, contact us and we can send you copies through the mail.
Avena Cancellation Policy
Avena services patients from all over New England who rely on the accuracy of our schedule. When scheduling your first appointment, a $200.00 deposit will be collected to hold your appointment time. This deposit will be applied to your first visit. If you need to cancel your appointment for any reason, it must be done at least 2 business days prior your scheduled appointment and will result in a full, immediate refund of your deposit. If you DO NOT cancel within the 2 business days prior your appointment, you will forfeit the deposit. Avena cares about our patients and works hard to make sure our schedule is able to meet the volume of requests which is why we use this policy. We thank you in advance for your consideration and acceptance of our cancellation policy.
- Please complete the applicable forms prior to setting up your initial appointment. For most patients, this means the Patient Intake Form and the Registration Packet. If you are 13 or under, please complete the Pediatric Intake Form and the Registration Packet. Once this is done, please email, fax or drop off the completed forms to our office and we can help set up your initial visit. Please note that we are currently scheduling New Patient Visits 6 months in advance.
- Provide us with copies of any current or pertinent laboratory/medical tests that you have available.
- Optional: You may want to bring in a list of all prescriptions and supplements that you are currently taking or have used recently if you are not able to provide detailed information in the Intake Form.
This form is absolutely critical because it details your health background and history. Since we are a integrative practice, this form is very extensive; completing it before you arrive for your first appointment is essential.
Pediatric Intake Form
Bringing your children to see us? If so, please fill out this intake form specific to patients who are under 13 years of age. If you are over 13, skip this form.
Registration Packet
This registration packet tells us your contact information and contains a number of legal agreements. It contains your consent for us to treat you, notifies you of our financial policies, and includes your acknowledgment that we have provided you with a copy of our Notice of Privacy Practices.
Notice of Privacy Practices
Our Notice of Privacy Practices details our HIPAA compliance regarding how we will and will not use your personal information. There is nothing to sign in this document. We make it available online only for your convenience. You can also get a print copy of it in our offices.
Having trouble viewing these forms? You need a program that will open PDF files. Adobe Acrobat Reader is free. If you still have trouble, contact us and we can send you copies through the mail.
Avena Cancellation Policy
Avena services patients from all over New England who rely on the accuracy of our schedule. When scheduling your first appointment, a $200.00 deposit will be collected to hold your appointment time. This deposit will be applied to your first visit. If you need to cancel your appointment for any reason, it must be done at least 2 business days prior your scheduled appointment and will result in a full, immediate refund of your deposit. If you DO NOT cancel within the 2 business days prior your appointment, you will forfeit the deposit. Avena cares about our patients and works hard to make sure our schedule is able to meet the volume of requests which is why we use this policy. We thank you in advance for your consideration and acceptance of our cancellation policy.