PREPARATION FOR YOUR APPOINTMENT:

 

We are excited to help you with your health care needs. Prior to your initial visit, we require that you complete and submit your new patient intake forms. This step is crucial in providing your health care provider with your pertinent medical history and health goals so they have adequate time to prepare for your visit. Our Prema Health practitioners are invested in your health and it is important to us be able to begin to create your individualized health plan before the  first visit.  Please see below for the necessary forms required for each modality.

 

As a service to our patients, Prema Health provides courtesy insurance billing for our in network patients/clients. However, it is the responsibility of the patient/client to provide the details of their insurance information. Please email us a picture of the front and back of your insurance card along with your DATE OF BIRTH!  IF YOU DO NOT HAVE INSURANCE COVERAGE, OR IF YOU HAVE NOT SUBMITTED YOUR INSURANCE INFORMATION BEFORE YOUR OFFICE VISIT, PAYMENT WILL BE DUE AT THE TIME OF SERVICE.  It is the patient’s responsibility to be aware of his/her coverage, as well as any deductibles and maximums. If insurance denies payment for any reason, the patient is responsible for full payment within 30 days of receiving a bill. Thank you for your cooperation.  Please be aware that insurance is not accepted for phone consultations.

If our practitioner/clinic is not in network with your insurance you will have to pay time of service charges and will be given the necessary paperwork to  submit to your insurance for direct reimbursement.

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Lastly, we will charge 100% of the visit cost if an appointment is missed or there is failure to reschedule 24 hours before the appointment. If you have any questions at all, please do not hesitate to reach out. 

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New Patient Intake Forms:

 

Accupuncture and Chinese Medicine:

• new patient intake form

• privacy rights information

• office policies and financial agreement

• consent to treat a minor

• Informed consent for acupuncture 

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Colon Hydrotherapy:

• ​new patient intake 

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Chiropractic Medicine:

• ​new patient intake 

 

Counseling Services:

• Ivy Katz, intake Form 

• Ivy Katz, adolescent intake

• Ivy Katz, parent intake

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Homeopathic Medicine:

• new patient intake form

• informed consent for medical care

• office policies and financial agreement

• privacy rights information

• homeopathic writing exercise

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Holistic Pelvic Care (TM):

• Intake and Consent

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Massage:

• ​new client intake and consent form

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Naturopathic Medicine:

• new patient intake form

• informed consent for medical care

• office policies and financial agreement

• privacy information rights 

• consent to treat a minor

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Naturopathic/Homeopathic phone consults:

• new patient intake form

• telephone informed consent form

• office policies and financial agreement

• privacy information rights 

• consent to treat a minor

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Skin Care Services:

• ​new client intake and consent form

• Lash Lift Consent Form

• Robin Schmitt intake form

• Informed Consent for dermaplaning

• Informed Consent for microneedling

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Tissue Rehab:

• ​Tissue Rehab Intake and Consent

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Yoga Therapeutics:

• ​Yoga Therapeutics Intake