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Patients are provided access to an electronic intake form through their patient portal.
If you are unable to access your online intake form, please download and complete the form below. You can then email it to firstname.lastname@example.org OR fax it to 888-972-5592.
Patients are required to submit paperwork no later than 48 hours prior to their first appointment.
If you have any problems or need a copy mailed to you, please call the office at (267) 406-0782.
Dr. Julie Lachman
Adult Intake Form (14 and older)
Children’s Intake Form (Newborn – 13)
Homeopathy Autism Questionnaire (For children in the ASD/Developmental Delay Program. Both the intake and this form must be completed.)
Lynn Amara, CCH