Patient Intake Forms

Please download the appropriate form(s) below and SAVE to your computer.

Minors – Patient Intake Form
Adults – Patient Intake Form


The pdf files can be saved/downloaded to your computer and opened in Adobe Acrobat Reader where you can fill the form out. Please fill out as completely as possible prior to your appointment.

After editing, the form can be saved and emailed to us at Please save the file by using “Save as” under the acrobat “File” menu and add your last name to the pdf.

Attach this to your email. Please include a note when emailing, referencing your appointment and any other important information or questions.

You may also, if you prefer, mail a printed out version to us at:

Center for Natural Healing
5410 North Scottsdale Road, Suite C-200
Paradise Valley, Arizona 85253

Please bring a copy with you to your appointment. If you are unable to complete on a computer, you may print out and fill in by hand, mail or bring in to your appointment. Questions can be emailed to: or we can be reached at 888-970-0077.