Registration Forms

Welcome to new patient registration! Please complete the following forms prior to your first appointment. 

New Patient Registration 

You CANNOT BE SEEN until the following forms are completed:

IMPORTANT INFORMATION ABOUT REGISTRATION:

  • Dr. Garner is not a participating Medicare provider. If you would like to be seen for wellness or maintenance programming ONLY and you are on Medicare, then please contact our office before scheduling an appointment.
  • Patient Privacy Disclosure Statement: In filling out the patient registration, I understand that EudeMOMia® will maintain my privacy to the highest standards and may use or disclose my personal health information for the purposes of carrying out treatment, obtaining payment, evaluating the quality of services provided and any administrative operations related to treatment or payment.

Medical Record Release Form

If you need to share your medical records from Dr. Garner’s office with another provider, this form must be completed. 

For Ayurvedic Consults Only

If any of these forms are needed Dr. Garner will have you complete them at a later date.

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