Alliance Institute for Integrative Medicine - Alternative healing & medicine

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6400 East Galbraith Road
Cincinnati, OH 45236

care options

Alliance Institute Care Options

new patient consult forms


Patient Information Patient Information (256 KB)

 

Intake Form Intake Form (251 KB)

 

Pain & Discomfort Pain & Discomfort (130 KB)

 

Consent Form Consent Form (146 KB)

 

Payment Policy Payment Policy (167 KB)

 

Non-Covered Services Non-Covered Services (71 KB)

 

Notice of Privacy Practices Notice of Privacy Practices (265 KB)

 

Preparing for Your Appointment Preparing for Your Appointment (254 KB)

 

Privacy Practices Acknowledgement Privacy Practices Acknowledgement (84 KB)

 


contact us

 

Alliance Institute for Integrative Medicine

 

6400 East Galbraith Road
Cincinnati, OH 45236

 

Phone: 513-791-5521
Fax: 513-791-5526



New Patient Consult Forms

New Patient Chiropractic Forms

Rolfing, Craniosacral, Massage Forms

Advanced Allergy Therapeutics Forms

Nutrition Consult Forms

Hypnotherapy Forms

Authorization Treat Minors
Directions