Patient Forms

Renewed Wellness Medical Center Patient Forms

If this is your first time or you have any changes in your medical history, you must complete our Medical Intake Forms below prior to receiving treatment. 

Patient Privacy Form

Our privacy consent form outlines how we collect, use, and protect your personal information in compliance with privacy laws and regulations. By downloading and completing this form, you acknowledge your understanding of our privacy practices and provide consent for us to handle your information accordingly. This document ensures transparency and trust between you and our healthcare institution, safeguarding your privacy rights.

Intake Form

Our patient intake form is designed to gather essential information about you, ensuring we provide the best possible care. This form covers details such as your contact information, medical history, current symptoms, allergies, and medications. By completing this form before your appointment, you help us streamline your visit and tailor our services to your specific needs.


Practice Policies

Our practice policies outline the guidelines and procedures that govern our interactions with patients to ensure a smooth and efficient experience. These policies cover various aspects such as appointment scheduling, cancellation and rescheduling, payment methods, insurance, confidentiality, and patient rights. By familiarizing yourself with our practice policies, you'll have a clear understanding of what to expect during your visits and how we strive to maintain high standards of service and professionalism. Download our Practice Policies document to stay informed and make the most of your healthcare journey with us.

Credit Card Authorization Form

Our credit card authorization form is a secure document that allows you to authorize us to charge your credit card for agreed-upon services or payments. By completing and signing this form, you give us permission to process transactions using your credit card details in a safe and confidential manner. This form helps facilitate convenient and efficient payment processing while ensuring the security of your financial information. Download our Credit Card Authorization Form to authorize payments hassle-free and enjoy peace of mind knowing your transactions are handled with care.