Forms

Dear Patient,

In the directory below, you will find several forms and questionnaires that we will need you to complete either prior to the first session or by the completion of the initial appointment.

 

When Printing forms at home, please make sure PRINTER SETTINGS ARE ON SINGLE PAGES, NOT "DUPLEX". FORMS NEED TO BE FILED INDIVIDUALLY AND CANNOT BE DOUBLE-SIDED.

 

Naturopathic Services:

 

MASSAGE Services:

 

chiropractic & Acupuncture Services:

To download and print full packet for Chiropractic & Acupuncture Services, click on link below. Complete informed consent forms as necessary for services that will be provided:


Beginning January 1, 2018, Pica & Associates has implemented a Payment Options Form to help facilitate the payment process and streamline billing. View the form here:


Please complete these forms to the best of your ability. All the above information will be vital in helping us fully understand you and help us to guide your treatment. Please contact our office if you have any further questions or concerns.

Sincerely,

Dr. Sarah Gerencher, ND, LMT, Naturopathic Doctor, Licensed Massage Therapist