Exceptional Wellness Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, click here to download.

• Download the necessary form(s), print it out and fill in the required information.

• Fax us your printed and completed form(s) or bring it with you to your appointment.

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NEW PATIENT HEALTH HISTORY FORM - REQUIRED

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This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

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Health History

Allergy Re-treatment Acknowledgement
Credit Card Authorization Form
EWC Plan Sheet
Face Sheet
Office Policies and Financial Agreement
Informed Consent for Exam
Notice of Privacy Practices

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