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Vizuri Health Center offers our patient form(s) via web access so you can complete them in the convenience of your own home or office.

New Patient Forms - Required

Please click on the link below to access our new patient web intake forms*.  You are required to provide an email address on this form for online submission.  If you do not have an email account, please complete the email field using [email protected].  

Completing this intake form prior to your first appointment provides us with the history and current state of your health. This allows us to focus fully on your experience as a new patient of Vizuri Health Center.  What are your questions, concerns, and goals regarding wellness? We are here to help, so let us know!

New Patient Web Intake Form

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form

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