Policies and Forms

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For your initial visit, please complete the forms at the right. It is essential for the completed forms to be received at least 1 week prior to your appointment.

Please print and mail completed forms and initial deposit to:

INTEGRATIVE CARE NJ
134 Main Street, 2A
Flemington, NJ 08822

(Note that additional forms may be sent depending on the reason for your visit.)

• Directions for completing forms
  
• Contact information
• Recent medical data
  
• Adult questionnaire (part 1)
  
• Adult questionnaire (part 2)
  
• Medical symptom questionnaire
  
• Toxicity questionnaire
  
• Stress questionnaire
• Walsh Approach Health History Form*
• Fee schedule/insurance waiver
• Credit card form

*Please complete only if you are considering an evaluation for mood disorder using the Walsh Approach.