Intake Forms

Following are some PDF versions of forms and documents that you will need when you become a patient at Middleway Health. You will need Acrobat Reader to view, print, and save these forms. You can get a free copy of Acrobat Reader here.

Intake Questionnaire and Other Forms.PDF (You can use Acrobat Fill and Sign to complete this form electronically or print the form and fill it out by hand).

Notice of Middleway Health Privacy Practices.PDF  (You may read this electronically or print it out and read it.)

Middleway Health Wellness Handbook.PDF (You may read this electronically or print it out and read it.)

Acknowledgement of Receipt of Wellness Handbook and Privacy Practices.PDF This is to acknowledge that you have read, understood, and agreed to both the Middleway Health Handbook and the Middleway Health Privacy Practices. (You can use Acrobat Fill and Sign to complete this form electronically or print the form and fill it out by hand).