Forms


 

Thank you for your interest in the services at The Health Improvement Center

Please fill out the New Client Intake Form, the Symptom Survey and the Terms of Acceptance Form. Be sure to bring all three completed forms with you to your first appointment. I look forward to seeing you!

New Client Intake Form Instructions:
Complete all pages of the New Client Intake Form and sign the last page.
Download

Terms of Acceptance Form Instructions:
Read and sign the Terms of Acceptance Form.
Download

Symptom Survey Form Instructions:
Please read the instructions for the Symptom Survey Form carefully and color in all the dots that apply. If you are unsure of a question then circle it. Feel free to elaborate on any questions. On the second page write in the five main complaints in the order of importance to you.
Download

Location
The Health Improvement Center
243 Church Street NW, Suite 100 A
Vienna, VA 22180
Phone: 703-249-6641
Office Hours

Get in touch

703-249-6641