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336-768-3335

Patient Screening RIH Forms

RIH Forms

You must fill out the New Patient Screening Form before we will review your intake forms...

Informed Consent for IV Therapy
Lyme Symptom Checklist
Medical Release
Medicare Private Contract
No Show Fee Waiver
Mold Symptoms
Sauna Consent
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  • 336-768-3335
  • 336-768-4171
  • Mon-Thurs: 8:30-4:45pm
    Friday: 8:30-2:30pm
  • 3288 Robinhood Rd. Suite 202
    Winston-Salem, NC 27106
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