Please download and fill out all of the forms on this page.
COVID-19 Related Forms
COVID-19 Consent Form (PDF)
While I am in the Office (PDF)
Past 48 Hours Questions (PDF)
Informed Consent (PDF)
New Patient Intake Form (PDF)
Notice of Privacy Practices (PDF)
New Patient Information (PDF)
Patient Symptom Survey (PDF)
If you are able please send the completed forms to firstname.lastname@example.org
When I receive them we will schedule a brief phone or Zoom consultation. At that time we will make an office appointment for the initial examination and treatment.
If for some reason you are unable to do the above……
Please call the office and leave a message letting me know that or send an email. I will return your call ASAP and we will find a solution to that problem.
Office phone: 858-481-9854
Thank you…I look forward to seeing you.
Nicolai Lennox, D.C.
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