Instructions

1. Please click the the link below to download or print our intake form.

2. Fill out all the information. With Adobe Reader, PDF can be edited electronically.

3. Please bring it with you into the office or email us the completed form prior to your first appointment.

Communication Permission form

Note: If you have previously submitted this form, you do not need to repeat

First Name

Last Name

Please check the box to Opt-in or Opt-out of permission to communicate by SMS text messaging:

Note: Vital Health Center uses your contact information solely to communicate about scheduling and appointments. We consider all your information and communications private and confidential. Please see the privacy policy Page. www.vitalhealthcenter.net/privacy-policy By checking this box, I agree to receive SMS messages about scheduling appointment communications from Vital Health Center at the phone number provided above. The SMS frequency may vary. Data rates may apply. Text HELP to 1-831-462-1132 for assistance. Reply STOP to opt out of receiving SMS messages.

Opt-in SMS test messages

Opt-out SMS test messages