Online Forms

The online intake is preferred, but we understand sometimes computers don’t do what we want them to.   Please complete this on a laptop or desktop computer (the form will not transmit when completed on a mobile device).  Sign using your mouse and then when completed, please click “submit” and the data will be securely transferred to our system.  You do not need to complete every entry on the form.  If something does not apply, simply skip that and go to the next question.  At the end, it may say fields are incomplete, but it will transmit okay!  In the event you are unable to complete the online version, or if you simply prefer paper, please choose the appropriate intake form below, print out, and bring with for your visit! Your other choice is to come 15 minutes early to your appointment to fill out the intake form in the office. 

Access To Health offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, click here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

Auto Accident Form  If you were in an auto accident, kindly print this form and bring it in with your visit instead of completing the online intake form.  (You will need Adobe Acrobat Reader installed to access the paperwork.  Click Here to Download Adobe Acrobat Reader for Free.)

Kids Ages 0-3 Form

Kids Ages 4-8 Form

Kids Ages 9-13 Form

Kids Ages 14-17 Form

Patient Privacy Policy

Download the Free Adobe Reader®