Longmont Institute: Intake Forms


Please download the appropriate Longmont Institute of Integrative Medicine PDF file for your upcoming visit.

 

 

Dr. Bereznoff's  Forms

New Patient Forms

  • ADULT Medicine and Surgery:        ADULT intake form.

This Form will take about 30 minutes of your time to complete, please come to the office with the form COMPLETED. Please do NOT attempt to complete the form in the office waiting room.

 

Existing Patient Forms

  • Annual Physical Examination Symptoms Review:   

   Symptoms Review Form.

 

  • Dr. Rabinowitz's Natural Medicine and Acupuncture intake form.

 

Call the office if you have trouble downloading the forms:   (303) 776-3202