Patient Forms

Here are the forms you will need as a patient of Natural Balance Wellness Medical Center. After you start seeing us more frequently, having these patient forms at easy access will be very useful to provide you the very best level of care.

New Patients

Please call the clinic at (734) 929-2696 to schedule your 1st appointment before completing the new patient paperwork.

New Patient Registration

New Patient History

Existing Patient Follow Up Forms

Existing Patients please ALWAYS complete your follow up form the day before your scheduled visit to allow our clinicians to provide the very best care possible.

Dr. Boggess Follow-Up Form

Dr. Baade Follow Up Form

Dr. Basinger Hormone Follow Up Form

Samantha Follow Up Form

CIRS Follow-Up Form

Dr. Basinger Hormone Clinic Patients

These forms are specifically for Dr. Basinger Hormonal New Patient Consults and Follow Ups. If you are having a Precision Medicine protocol follow up appointment with Dr. Basinger, please use the Follow Up form provided above.

Bioidentical Hormone / New Patient Questionnaire

Bioidentical Hormone Follow-Up Form

Other Clinical Forms

Starting New Supplements

Review Of Systems (ROS) Subjective Scale

Need Help With Your Forms?

If you have any questions about which forms to complete or need assistance, please don't hesitate to contact our office.

Request Appointment Call (734) 929-2696