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Phone 408-333-9092 - Fax 408-333-9798

Integrative Medical Associates

Forms

Please click on appropriate document required to print.

New Patient Package

General Forms

Credit Card Authorization

Medical Release/Records Request Form

Lyme Treatment Form

Authorization for Unencrypted
Transmissions

Allow 5-10 working days for processing. Records to be mailed totaling over 5 pages will incur a .25 cent per page charge plus mailing.

Medicare Questionairre

Notice of Privacy Form

Informed Consent Form

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