DID YOU REMEMBER TO…?

• Read all of the practice documents.

• Obtain your medical records and/or test results from previously seen physicians and have them sent to The UltraWellness Center at 45 Walker Street, Lenox MA 01240, arriving at least 7 days prior to your appointment date.

• Provide your preferred shipping/mailing address; if listing a P.O. Box please indicate a street address for receiving packages via UPS or FED EX.

• Provide us with your pharmacy name, address, phone and fax number.

Did you fill out and/or sign the following forms:

• Important Patient Information

• Authorization for Release of Medical Information

• Informed Consent Regarding Email or the Internet Use Of Protected Personal Information

• Research Consent Form

• Notice of Medicare Denial

• General Information

• Medical Questionnaire

• 3-Day Diet Diary

• MSQ – Medical Symptom/Toxicity Questionnaire