IMC Provider

NIMC Forms

We appreciate you taking the time to review the forms and information needed for your visit at Integrative Medical Clinic. If you have questions or difficulties, please contact us.

We recommend completing all forms for your initial visit PRIOR to arrival.

New patient forms for physician appointments can take about 30 minutes. All new patients to the clinic need to complete the Patient Registration form. Some providers also require an additional Intake form to be completed. Please consult the forms below.

Most of the forms can be completed online or printed out and completed by hand. Be sure to bring a copy of the completed form(s) to your scheduled appointment.

The Steps to Complete Your Forms:

  • Patient Registration form is required for all new patient appointments.
  • In addition, some providers have a practice-specific, health intake form to be completed. Check the Additional Intake list, which is sorted by Provider.
  • Click on the form you need to complete and a PDF file will open on the screen, or you will be asked to download the file to your computer.
  • PRINT the form and complete it by hand. Some of the PDF files can be filled out using your computer. Just click each field and type your information. You can then save the completed PDF form to your computer and print a copy to bring to your appointment.

All New Patients Complete:

Additional Required Intake Forms:

Other Forms:

Please Bring Completed Forms, Insurance Card(s), and Photo ID to Your Initial Consultation/Treatment.

  • Print out the completed form(s) and bring to NIMC for your appointment.
  • If you are unable to print, you may email completed forms to
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“From my intake at the front desk of the very soothing office through my exam by board-certified ENT specialist, C. Robert Pettit, M.D., my experience was top notch.” - IMC Patient

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Naturopathic Integrative Medical Clinic of Santa Rosa
175 Concourse Blvd.
Santa Rosa, California 95403

How Can We Help YOU?

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Call 707-284-9200