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Patient Initial Treatment Forms

All patient information will be kept confidential according to the HIPAA medical confidentiality act.

Treatment forms

Please fill out the following four forms and bring them with you to your first treatment.

Health history form

Notice of information practices

Consent to treatment form

Permission to leave a message/Emergency contact information form


Other forms

Testimonial form

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• 730 Boston Post Rd • Suite 28 • Sudbury MA • 01776 • Phone (508) 740-1424 • anevard@goodchiboston.com