New Patient Registration and Agreement

Welcome to Soul Shine Functional Medicine!

If you are reading this, you have successfully registered as a new patient with us. Congratulations and welcome!

The purpose of this form is for you to authorize us to provide treatment. Please fill out and submit the New Patient Registration and Agreement Form (at right). Once we receive this form, we will contact you to confirm that you are scheduled for your Case Review appointment.

Please review the New Patient Agreement before completing the form.

We look forward to partnering with you to help you achieve optimal health!

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