IMPORTANT ANNOUNCEMENT NOVEMBER 21, 2022

Crouch Clinic
Crouch Clinic
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  • More
    • Home
    • Services
      • Weight loss
      • Weight Loss Prices
      • IV Therapy
      • Injections
      • Services
    • About
      • About Our Clinic
      • Meet Our Staff
      • Philosophy
    • Resources
      • Video Messages
      • Food Plans
      • Links
    • Contact Us
    • Important Announcement
    • Patient Portal
    • Forms
    • Clark Wellness, PLLC
  • Home
  • Services
    • Weight loss
    • Weight Loss Prices
    • IV Therapy
    • Injections
    • Services
  • About
    • About Our Clinic
    • Meet Our Staff
    • Philosophy
  • Resources
    • Video Messages
    • Food Plans
    • Links
  • Contact Us
  • Important Announcement
  • Patient Portal
  • Forms
  • Clark Wellness, PLLC

Printable forms

Patient History Form

Download, print, complete, and bring a copy of this form with you on your first visit to save you some time! This form is necessary for any New Patient or any patient who has not been in the clinic in more than a year.

Patient History Form (PDF)

Download

Consent to treat minor

If the patient is under the age of age of 18 at the time of the appointment, be sure to print and have a guardian complete a copy of this form prior to the visit.

Consent to Treat Minor (PDF)

Download

Additional documents

These are additional documents for your information. You do not have to bring these on your first visit unless they pertain to your medical history.

Constipation Handout (PDF)

Download

Thyroid Instructions (PDF)

Download

Copyright © 2022 Crouch Clinic - All Rights Reserved.

  • Weight loss
  • About Our Clinic
  • Meet Our Staff
  • Food Plans
  • Links
  • Contact Us
  • Patient Portal
  • Forms