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

Acupuncture Appointment

• Acupuncture Intake

Nutrition Appointment

• Nutrition Therapy – New Client Intake Form

Massage Appointment

• Massage Intake

Psychotherapy Appointment

• Mind-Body Therapy Intake Form

Yoga Therapy Appointment

• Patient Demographics
• Yoga Intake Form

Facility Use Waivers

• Client Facility Use Waiver
• COVID Facility Use Waiver