New Patient Forms

Instructions for New Patients 

Thank you for trusting Darien Integrative Medicine. Completion of the NEW PATIENT FORM is required before scheduling. 

Please complete the required forms using desktop or laptop. Do not use iPhone, iPad or smartphone. 
Allow-up to 45 minutes to complete 
Answer all questions; type N/A or not applicable if questions do not apply. 
Do not hesitate to call us if you encounter technical difficulty. We are here to help. 

To make the most of your appointment, please: 
Plan to arrive 15 minutes early for check-in; please consider traffic. 
If you have one, bring a copy of your recent thyroid ultrasound or biopsy. Do not bring the original. 
Do not bring other medical records. We will ask you for what we need. 
Dress comfortably you will be asked to change into medical scrubs before a physical examination 
Write down your questions, we will try to answer as many as your appointment time will allow 
Understand that we will NOT order blood work before the appointment. 

Thank you. 


NEW PATIENT FORMS

FORM #1: Consent Form (Medicare Patient Only) 

FORM #1: Consent Form (Non-Medicare Patient Only)

FORM #2: Evaluation Form -- DO NOT START WITHOUT COMPLETING THE CONSENT FORM first. Call us immediately after completion to schedule your appointment.

 

Location
Darien Integrative Medicine
6 Thorndal Circle, Suite 102
Darien, CT 06820
Phone: 203-324-4747
Fax: 203-344-4914
Office Hours

Get in touch

203-324-4747