Paperless Patient Information

Medicinal Life is going green and saving trees by eliminating the amount of paper being used. Not only will this save our environment, but it will also save your time that would have had you sitting in our office filling out the papers. Now you can do them at your leisure in your own home.

The information that you send to us is not shared with anyone without your written consent.
If you are a new patient, please fill out all of the forms as complete as possible and click on the “E-mail Form” at the top of the page when you are finished.

If you are a returning patient that has not had a treatment within 3 months, please fill out the “Chief Complaint Form” and then click on the “E-mail Form” on the top of the page.
The information is sent directly to our office as soon as you submit it.

There are 2 ways that the forms can be sent. The first is the easiest, but requires Microsoft Outlook, Eudora or Mail program and all you have to do is click “Email Form” after filling out each form. The second way requires you to save the file to your computer and then send the file through your email service. When you save the .xml file, you may want to write down where the file is being saved, to be able to send it to info@medicinallife.com

Certain internet browsers are not using Adobe Reader to open up these pages and some will not let you fill in the pages. Google Chrome and Safari are two of the browsers that we have found do not work. We are sorry for any inconvenience if you are using these programs. Internet browsers that do use Adobe Reader are Firefox, Internet Explorer and Camino. If you are not able to email the paperwork to us, please show up at least 15 minutes before your appointment to fill out the paperwork in the office. Again we are sorry if there is any inconvenience with this process.

Patient Intake Form(click, fill and submit)

Chief Complaint Form(click, fill and submit)

Family And Past Medical History(click, fill and submit)

Privacy Form(click, fill and submit)

ROS Form(click, fill and submit)