Forms
[vc_row][vc_column width=”1/2″][vc_column_text]
Patient Forms
Below you will find our forms for new clients, if you have any questions please call us 401-461-9355. Once you complete the forms, please bring them to your first appointment.[/vc_column_text][vc_column_text]A continuación encontrará nuestros formularios. Si usted tiene alguna pregunta por favor llame (401) 461-9355. Una vez que complete y firme los formularios, por favor traiga a su primera cita.[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_column_text]
[/vc_column_text][/vc_column][/vc_row][vc_row el_class=”downloadheading” css=”.vc_custom_1451741866012{margin-bottom: 5px !important;border-bottom-width: 0px !important;padding-top: 0px !important;padding-bottom: 0px !important;}”][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″][vc_column_text]
Forms / Formularios
[/vc_column_text][/vc_column][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″][vc_column_text]
English
[/vc_column_text][/vc_column][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″][vc_column_text]
Español
[/vc_column_text][/vc_column][/vc_row][vc_row css=”.vc_custom_1451697665433{margin-top: 5px !important;margin-bottom: 5px !important;border-top-width: 0px !important;border-bottom-width: 0px !important;padding-top: 0px !important;padding-bottom: 0px !important;}”][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″ css=”.vc_custom_1451741894290{padding-top: 0px !important;}”][vc_column_text css=”.vc_custom_1451742066595{margin-bottom: 10px !important;padding-top: 10px !important;}”]
Copy of Privacy Practice/HIPPA
[/vc_column_text][/vc_column][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″ css=”.vc_custom_1451741904442{padding-top: 0px !important;}”][vc_btn title=”View / Download” color=”green” size=”sm” align=”left” i_icon_fontawesome=”fa fa-download” add_icon=”true” link=”url:http%3A%2F%2Fwww.thewellnesscenterri.com%2Fwp-content%2Fuploads%2F2016%2F01%2FPrivacy-Practices-2016-Eng.pdf||” css=”.vc_custom_1451742115070{margin-bottom: 10px !important;}”][/vc_column][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″ css=”.vc_custom_1451741918832{padding-top: 0px !important;}”][vc_btn title=”View / Download” color=”green” size=”sm” align=”left” i_icon_fontawesome=”fa fa-download” link=”url:http%3A%2F%2Fwww.thewellnesscenterri.com%2Fwp-content%2Fuploads%2F2016%2F01%2FPrivacy-Practice-2016-Spanish.pdf||” add_icon=”true” css=”.vc_custom_1451742125355{margin-bottom: 10px !important;}”][/vc_column][/vc_row][vc_row css=”.vc_custom_1451697665433{margin-top: 5px !important;margin-bottom: 5px !important;border-top-width: 0px !important;border-bottom-width: 0px !important;padding-top: 0px !important;padding-bottom: 0px !important;}”][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″ css=”.vc_custom_1451741942170{padding-top: 0px !important;}”][vc_column_text css=”.vc_custom_1451742195539{margin-bottom: 10px !important;padding-top: 10px !important;}”]
New Client Agreement Forms
[/vc_column_text][/vc_column][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″ css=”.vc_custom_1451741949409{padding-top: 0px !important;}”][vc_btn title=”View / Download” color=”green” size=”sm” align=”left” i_icon_fontawesome=”fa fa-download” add_icon=”true” link=”url:http%3A%2F%2Fwww.thewellnesscenterri.com%2Fwp-content%2Fuploads%2F2015%2F03%2FNew-Client-2016-Forms-English-3.pdf||” css=”.vc_custom_1451742204419{margin-bottom: 10px !important;}”][/vc_column][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″ css=”.vc_custom_1451741957880{padding-top: 0px !important;}”][vc_btn title=”View / Download” color=”green” size=”sm” align=”left” i_icon_fontawesome=”fa fa-download” link=”url:http%3A%2F%2Fwww.thewellnesscenterri.com%2Fwp-content%2Fuploads%2F2015%2F03%2FNew-Client-2016-Forms-Spanish-3.pdf||” add_icon=”true” css=”.vc_custom_1451941735399{margin-bottom: 10px !important;}”][/vc_column][/vc_row][vc_row css=”.vc_custom_1451697665433{margin-top: 5px !important;margin-bottom: 5px !important;border-top-width: 0px !important;border-bottom-width: 0px !important;padding-top: 0px !important;padding-bottom: 0px !important;}”][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″ css=”.vc_custom_1451741984609{padding-top: 0px !important;}”][vc_column_text css=”.vc_custom_1451742150241{margin-bottom: 10px !important;padding-top: 10px !important;}”]
Authorization for release of information
[/vc_column_text][/vc_column][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″ css=”.vc_custom_1451741978848{padding-top: 0px !important;}”][vc_btn title=”View / Download” color=”green” size=”sm” align=”left” i_icon_fontawesome=”fa fa-download” add_icon=”true” link=”url:http%3A%2F%2Fwww.thewellnesscenterri.com%2Fwp-content%2Fuploads%2F2015%2F03%2FAuthorization-for-Release-of-Information-English-2.pdf||” css=”.vc_custom_1451742159603{margin-bottom: 10px !important;}”][/vc_column][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″ css=”.vc_custom_1451741991384{padding-top: 0px !important;}”][vc_btn title=”View / Download” color=”green” size=”sm” align=”left” i_icon_fontawesome=”fa fa-download” link=”url:http%3A%2F%2Fwww.thewellnesscenterri.com%2Fwp-content%2Fuploads%2F2015%2F03%2FAuthorization-for-Release-of-Information-Spanish-2.pdf||” add_icon=”true” css=”.vc_custom_1451742168755{margin-bottom: 10px !important;}”][/vc_column][/vc_row]
[/vc_column_text][/vc_column][/vc_row][vc_row el_class=”downloadheading” css=”.vc_custom_1451741866012{margin-bottom: 5px !important;border-bottom-width: 0px !important;padding-top: 0px !important;padding-bottom: 0px !important;}”][vc_column width=”1/3″ offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-4″][vc_column_text]
