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Natura Medica
The Center for Natural Medicine
1/9
New Patient Forms
Required before first appointment
ADULT
INTAKE
FINANCIAL
RESPONSIBILITIES
PEDIATRIC
INTAKE
FINANCIAL
RESPONSIBILITY
PAGE 2
INSURANCE
FORM
HIPAA Form
& CONTACT
OFFICE HOURS
Monday 8:00 – 5:00
Tuesday 8:00 – 5:00
Wednesday 8:00 - 1:00
Thursday 8:00 – 5:00
Friday 8:00 – 1:00
Natura Medica
frontdesk@naturamedicamystic.com
12 Roosevelt Avenue
Mystic, CT 06355
Phone:860-572-9566
Fax: 860-572-7318
Information
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Health Insurance Coverage
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Pharmacy
Additional Forms and Information
Release of Medical Records
Patient Payment Plan
Annual Comprehensive
Wellness Visit Form
HIPAA: Privacy Practices Pg1
(information purposes only)
HIPAA: Privacy Practices Pg2
(information purposes only)
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