New Patient Forms
Required before first appointment

Patient Intake Form

Financial Responsibilities

Pediatric Intake Form
HIPAA Form

Additional Forms and Information

Release of Medical Records
Patient Payment Plan
Annual Comprehensive
Wellness Visit Form

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

HIPAA: Privacy Practices Pg1
(information purposes only)
HIPAA: Privacy Practices Pg2
(information purposes only)