Health Sphere Wellness Center

Paperwork

To save time on your first visit, please consider reviewing and completing your paperwork ahead of time. The forms are provided below. Please print them, fill them out, and bring them with you on your first visit. Do not hesitate to contact us if you have questions about the forms. Our friendly staff will be happy to assist you.

We are now Direct Access; however, please check with your insurance coverage to see if a doctor's order is required. If you are a Medicare patient, a doctor's order is required. Please bring these completed forms along with your doctor's order (if required) to the first visit.

Adult Forms

English

  • Authorization to Referring Doctor PDF
  • Consent of Treatment | PDF
  • Family History PDF
  • Health History PDF
  • Patient Financial Responsibility Consent Form PDF
  • Patient Info PDF

Spanish

  • Authorization to referring doctor PDF
  • Confidential Health History PDF
  • Consentimiento para los Propositos de Tratamiento PDF
  • Family History PDF
  • Patient Information PDF

Children's Forms

English

  • Authorization to Referring Doctor PDF
  • Family History PDF
  • Health History PDF
  • HSWC Therapy Agreement PDF
  • Medical Release Family Members PDF
  • Patient Info PDF
  • Permission To Treat a Minor PDF
  • Photo Release PDF

Spanish

  • Authorization Release of Info PDF
  • Authorization to referring doctor PDF
  • Confidential Health History PDF
  • Family History PDF
  • Patient Information PDF
  • Permission to treat minor PDF
  • Photo Release PDF
  • Therapy Agreement PDF