Bloomfield Total Health Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Health History Form - Required
This lets us know the history and current state of your health. What questions, concerns and goals, regarding your condition, we can help you with? Let us know!
New Patient Office Registration Form-Required
This form provides current insurance and billing information that will allow us to verify insurance coverage for you and your families care, at no cost.
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