Online Forms

Pavlik Center for Health and Wellness 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.

New Patient Intake - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

New Patient Intake Form


New Patient Consent, No Show and HIPAA Form- Required

Please download, print and sign form and bring with you to your appointment. Thank you.

CONSENT.pdf

HIPAA.pdf

NO-SHOW.pdf


Disclosure of Common Ownership Interest

DISCLOSURE-OF-COMMON-OWNERSHIP-INTEREST.pdf


Assignment of Benefits

ASSIGNMENTOFBENEFITS FORM.pdf



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Locations

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Office Hours

Our Regular Schedule

Monday:

7:30 am-6:30 pm

Tuesday:

7:30 am-6:30 pm

Wednesday:

7:30 am-6:00 pm

Thursday:

7:00 am-6:00 pm

Friday:

7:30 am-6:00 pm

Saturday:

8:00 am-1:00 pm

Sunday:

Closed