Patient Forms

We look forward to welcoming you to Duke Integrative Medicine.

Once you have confirmed your appointment date, please complete the appropriate intake forms, as directed by our staff.

Please submit your completed forms to a confidential medical records via fax: 919-681-0380.

Please be sure your forms are delivered to our facility one full week prior to your appointment.

Physician Appointment (for patients 18 and older)

• Personal Health History and Self Reflective Inventory
• Client Agreement and Waiver
• Release of Medical Records

Pediatric Functional Medicine Appointment (for patients 18 and younger)

• Pediatric Medical Intake

Acupuncture Appointment

• Acupuncture Intake
• Client Agreement and Waiver

Nutrition Appointment

• Nutrition Therapy – New Client Intake Form
• Client Agreement and Waiver

Massage Appointment

• Massage Intake
• Client Agreement and Waiver

Psychotherapy Appointment

• Psychology Referral Form
• Psychology Intake Form
• Client Agreement and Waiver

Yoga Therapy Appointment

• Patient Demographics
• Yoga Intake Form
• Client Agreement and Waiver