Forms & Policies

Special Note: Dr. Liz has a home practice and two friendly cats. They are not allowed in the treatment room area. Please let Dr. Liz know ahead of time if you have any concerns. Thank you.

Forms

New Patient Intake Form

New Patient Consent Form

Please fill out these forms before meeting with your doctor. You may print them and bring them with you to your appointment, or you may fill them out and email them to your provider.

If you do not fill out the forms before your visit, please plan to arrive 10-15 minutes early for your appointment to complete the forms at this time.

If you have any recent bloodwork, imaging studies, or other records that you would like your doctor to review, please bring them to your appointment.

Policies

Payment
Due at time of service. I accept cash, check, and all major credit cards, including HSA cards.

There is a 3% convenience fee for all credit, debit, and HSA card transactions

Fragrances
New Leaf Natural Medicine is a fragrance free environment. Many patients are sensitive to synthetic fragrances, so please refrain from wearing perfume and strongly scented clothing or body products.

72 Hour Cancellation Notice
If you are unable to make your appointment, please give at least 72 hours notice before your scheduled time. If less notice is given, 100% of your appointment fee will be due unless I can find someone to take your spot. If circumstances are out of your control, please speak with me about an exception. Thank you!

Insurance
I’m not contracted with any insurance companies but I’m happy to provide you with a superbill you may submit to your insurance company for reimbursement. Reimbursment dpeneds on your plan and company.

If you do have insurance and will be relying on reimbursement for your care, it is generally helpful to call your insurance company and confirm that you have out-of-network benefits.