Patient Forms

Integrative Physical Medicine offers our patient form(s) online so they can be completed it in the convenience of your own home or office.


Clermont

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=b00b71e2-eed5-4351-b636-27995c9d58e3&env=na3-eu1
Spanish New Patient AUTO https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=13c63dc1-9cd5-4276-88b1-93e7b751e3a5&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=e6b4b5c8-fc4f-4b27-a862-d5e30b735bfb&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=d693d176-cf21-4a5a-98d1-8d84fd2e22fb&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=87d83f38-cc4d-4f70-8b27-cc265fdcb2ab&env=na3-eu1

Debary

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=e0e285c3-c72f-4e5e-8c26-a7020cab7aa2&env=na3-eu1
Spanish New Patient AUTO https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=60bfe08a-5603-4ac8-8283-6fc19749ffd7&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=1dbdbf50-d878-4b45-a86a-954a25c2b293&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=1b19f339-794d-4a9c-b6d9-86bfe9c81501&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=b634241e-500e-4f38-b0bd-4ba876e24382&env=na3-eu1

Downtown

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=35b6283a-9979-4222-8edf-43f39b9fddbd&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=108da991-eb91-45f8-93b6-839476f97e30&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=844f2723-41ba-4055-bfe8-da4253c591de&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=8e66b1ee-09d1-4307-84b3-6a151a94ebec&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=45a2a241-ab82-4b6e-b0a6-974d10ce9886&env=na3-eu1

Eustis

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=b02b43b5-0cd4-43b3-b908-a620e7c10e02&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=30a00e3e-a416-47d6-94d3-fb45e4a6357b&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=121123ce-6975-4b64-9cd3-e26cdf10f762&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=4fdeb650-5b81-49ac-b578-6b5f98a48a75&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=17e5ff04-35e3-4046-9e8c-e54d4e4a70e9&env=na3-eu1

Kissimmee

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=5b4abab7-818e-42cc-8be8-b666604fb001&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=0a70f14e-7810-40f8-bd9d-832c97011f51&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=5b7ce844-9765-4e27-b125-2217b00210f2&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=496f85b6-217f-4b61-999e-4649615cfea9&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=eda2e690-a172-432b-a96d-b638ec9e5b8a&env=na3-eu1

Lake Mary

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=322cffee-d392-4ae5-8cc1-b72b410b78a7&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=34af446b-b6df-402d-acde-df8e6369aaf5&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=5fefadef-f887-46bc-8d45-61613f6f8948&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=79e60e4d-6ac9-42c6-99c9-c3c223ace338&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=f694ed23-756a-4b39-8e21-d7d983a0afd7&env=na3-eu1

Lakeland

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=7868e235-11f7-4508-8bac-ce18c443e95f&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=da1a5f50-2617-4f3e-959c-83bfb42e3a19&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=c4b95032-6a7e-4ed4-aeaa-a895e82ddc9e&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=36c0a152-ee47-44c6-b19d-c273258ef5ce&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=b0c21dda-8348-4fe4-89f6-ceca805b0a1f&env=na3-eu1

Maitland

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=926df465-0ee0-4e4f-a1c7-9a2173574318&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=b8f0cd50-1032-40f3-8ceb-f13811053334&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=e46962fe-b5f0-4515-af7b-75278a4128bd&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=a54ec7d9-4705-432d-88f2-639bb706ce6c&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=9261f376-e6ef-4239-8959-8d7372c47f51&env=na3-eu1

Metro West

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=c6db45c9-bc39-48b4-89db-198356740beb&env=na3-eu1
Spanish New Patient AUTO Inake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=63565e82-c7c2-4c53-8828-407208a2e1da&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=a155771c-b5e0-4971-b954-9d8631c48229&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=5f3d0ac2-a4a9-4239-8d09-8ee04bfb38fc&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=b62fc477-35f5-4848-8b43-da9dd67b0dd4&env=na3-eu1

Oviedo

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=c7a48669-2ec2-4aa2-9874-759bcaa78874&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=7770564d-edba-4ac7-a481-2d61e6fc5bdb&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=8304dfad-563b-4162-b778-70e8036c5aea&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=07494e76-e3f4-41a8-a866-3022f6d4a2ac&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=a574d492-1a93-460e-9178-a9d379fad55a&env=na3-eu1

Plant City

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=2b41fa5e-d84b-49f2-be5d-f7667d127fde&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=92cfc55e-9fe0-4876-a5bf-0e5fc96a64ab&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=c2db4117-947c-4d75-982d-ec30adcb0115&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=bc8e3695-e9bd-4b60-9c3e-1207d0e6969c&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=56575e25-1a3d-464b-99d6-8890ed7da23f&env=na3-eu1

Sanford

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=90c4feff-0032-4118-860f-998abb32d111&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=00a873d5-d23a-452a-a4eb-6cf47d90fa12&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=fb89d71a-91f3-476f-904b-8ba17f2c5f03&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=9dd5ca98-4fed-48ee-98b9-96d6edc1f369&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=3710f113-9101-4d16-9f86-3af5c5d82fc4&env=na3-eu1

The Villages

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=a1c80f03-b0bb-4b95-9c42-ecb18e6c59ae&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=a98f7170-d81b-414d-872e-4bd7dbcf83e1&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=18f5742e-bdaf-41a2-aca0-622f5d7fa11e&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=e59d58ab-75d0-4978-af62-aab7ca52ec7d&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=fa2762bf-6450-4b33-bd15-bc091ef20c29&env=na3-eu1

Waterford

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=b2c5e3df-cd74-4215-8512-8c80ab09e1ca&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=5186109d-bff5-452d-841a-16af861e8606&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=4de8eedc-682f-4282-8183-24277de18c7b&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=13bd7884-f2b6-4ea6-9fc5-b397a5f0040d&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=d7d870e4-eec2-489a-a36e-70d731272a09&env=na3-eu1

West Orlando

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=31eab5f7-8f33-469e-95be-ea0908e3caff&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=051d4f8e-5a58-4d23-b487-79dbf9bc7cb9&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=11de8df0-336d-4dd8-8b27-723d79d93446&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=f047464a-34a7-4471-905b-cf283fb270c3&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=e2121bd0-9fbf-4710-9b88-a8d6651234d8&env=na3-eu1

Winter Haven

New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=f2afb36f-e6ab-4551-b7b9-77c250c8ed5b&env=na3-eu1
Spanish New Patient AUTO Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=a6010310-a667-498c-8b99-4255ea97904f&env=na3-eu1
New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=a9b7be29-6f60-4b83-9022-36b6b1d44b68&env=na3-eu1
Spanish New Patient Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=afd33ab5-daee-4395-9a21-3f0dffe56e9d&env=na3-eu1
Pediatric Intake: https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=8d84b40b-0ea1-4a87-871c-cefc357f24cd&env=na3-eu1

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