NEW PATIENT FORMS
NEW PATIENT FORMS
Thank you for choosing Lewis Family Natural Health for naturopathic health care. We look forward to meeting you soon!
In preparation for your first appointment, please download and complete the following information forms.
Please also review our Policies and Fee Schedule, and let us know if you have any questions.
New Patient Series:
Please fill out these forms if you are coming in for the New Patient Series. It is very important that you have these forms filled out before your appointment. Please bring these completed forms to our office before your visit so the doctors will have a chance to review them. If you have not had a chance to fill out these forms ahead of time, then please arrive at least 45 minutes before your scheduled appointment time to fill them out in the office.
Adults:
Children (12 and Under):
Wellness Consultation:
If you are coming in for a one-hour wellness consultation, these are the forms for you to complete.
Acute Illness:
If you are new patient to our office coming in with an acute illness, this is the form for you to complete.
UltraLite Weight Loss Program:
Please fill out this form before your first UltraLite appointment.
Records Release Form:
If you need to obtain your records from another health care provider, you can download a PDF version of our records release form. This form should be completed, signed and dated, and sent to your health care provider. If you need help filling it out, please ask.
Directions to the Office:
Click here for a map and written driving directions.
Additional Information on Appointments
For additional information on what to expect for your appointment, you may want to read the following sections of our website:
Natural Therapies: Details on the most common therapies used, including homeopathy, herbal medicine, nutrition, and detoxification.
Appointments: This details what is included with your appointment and what to expect.
Common Questions: The answers to our most Frequently Asked Questions can be found here. If there is a question we have not answered, please contact us.
Policies and Fee Schedule
Payment: Payment is expected at the time services are rendered. We accept cash, personal checks, and credit/debit cards (Visa and Mastercard only). There is a $25 fee for returned checks.
Deposit: Because our doctors only schedule one patient at a time, we ask for a $100 deposit to reserve all new patient visits. This deposit is applied to the cost of the first visit, and is fully refundable (minus a $15 processing fee) for appointments changed with at least 48-hours (2 business days) notice.
Cancellation policy: We have a 48-hour cancellation policy. For cancellations made less than 48-hours before your scheduled appointment, we reserve the right to charge a $50 fee for follow-ups; new patient visits will forfeit the $100 deposit. Missed appointments with no notice given will be billed for the full amount of the scheduled visit. We are willing to make exceptions for true emergencies that may prevent you from keeping your appointment; please contact us as soon as possible to make arrangements.
Insurance: At this time insurance plans in North Carolina do not cover naturopathic healthcare. Some HSA/Flex spending accounts will cover our services and products; please check with your plan for details.
For more details on our policies and for a complete listing of our prices and services, please download our complete policy and fee schedule here. This document is also included with the New Patient Packets listed above.
