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CSUSM School of Nursing Introduction to Integrative Health

Intake Forms and the Integrative Healthcare Visit

This folder contains a variety of excellent examples of intake forms that you might use during an Integrative Healthcare visit. Most of them came from Duke University. The CSUSM SoN Student-Run Free Clinics have their own intake forms including an Integrative Healthcare Form that must be signed by the patient/client in order for them to receive integrative services. Look around and see what you might like to use.

    • acupuncture-intake.pdfacupuncture-intake.pdf
    • client-agreement-waiver.pdfclient-agreement-waiver.pdf
    • client-intake-massage.pdfclient-intake-massage.pdf
    • CSUSM SoN Integrative Healthcare Consent Form.pdfCSUSM SoN Integrative Healthcare Consent Form.pdf
    • CSUSM SoN New Patient Packet Adult.docxCSUSM SoN New Patient Packet Adult.docx
    • dim-nutrition-therapy-intake-form1.pdfdim-nutrition-therapy-intake-form1.pdf
    • DukeIM-health-psych-intake.pdfDukeIM-health-psych-intake.pdf
    • DukeIM-health-psych-referral.pdfDukeIM-health-psych-referral.pdf
    • Guest-Demographics-040616-002.pdfGuest-Demographics-040616-002.pdf
    • Intake-form-update.pdfIntake-form-update.pdf
    • release-of-medical-record.pdfrelease-of-medical-record.pdf
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