Scala Naturae

Integrative Health

Patient Forms

New and returning patients may access SNIH forms below. For your privacy, please submit completed medical forms through the secure CharmHealth Patient Portal rather than regular email.

Complete Forms Securely Online

Use the CharmHealth Patient Portal to complete intake questionnaires and securely submit health information.

Open Patient Portal Book Appointment

Downloadable Forms

These PDF forms are provided as backup copies. Use the portal whenever possible for HIPAA-compliant submission.

Full Integrated Intake Packet

Open or download this SNIH patient form. Please submit completed forms through the secure CharmHealth Patient Portal whenever possible.

Open Form

HIPAA Form

Open or download this SNIH patient form. Please submit completed forms through the secure CharmHealth Patient Portal whenever possible.

Open Form

Insurance Payment Information Form

Open or download this SNIH patient form. Please submit completed forms through the secure CharmHealth Patient Portal whenever possible.

Open Form

Medication / Allergy / Pharmacy Form

Open or download this SNIH patient form. Please submit completed forms through the secure CharmHealth Patient Portal whenever possible.

Open Form

Telehealth Consent Form

Open or download this SNIH patient form. Please submit completed forms through the secure CharmHealth Patient Portal whenever possible.

Open Form

Release of Information Authorization Form

Open or download this SNIH patient form. Please submit completed forms through the secure CharmHealth Patient Portal whenever possible.

Open Form