Healing for Life, LLC

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Patient Intake Form

****Please remember that filling out our online forms DOES NOT automatically schedule an appointment in our system, you will still need to contact the office to schedule.*****Welcome to our online Patient Intake Form. The information you fill in will be sent directly to our office, speeding up your office visit and allowing us to better serve your healthcare needs.

Who are you?

Let's get started. Fill out the fields below to speed up your office visit.