New Patient Forms
We want to personally welcome you the Alpine Valley Wellness Center website - we are looking forward to meeting you in person. Below are the new patient forms for Dr. Thomas and Dr. Piscopo. Please click on the appropriate link below and follow the directions outlining how to access the forms you will need for your appointment.
We look forward to seeing you.
New Patient - Dr. Thomas
Below are all the forms necessary for your appointment with Dr. Thomas. Please download all the forms below, fill out those that need to be filled out, and bring them to your appointment.
- Medical History Form
- Finance/Insurance Form
- Office Policies Form
- Informed Consent For Treatment
- Non-Covered Services: Consent for Treatment
- Notice of Privacy Practices
- Getting the Most from Your Medical Visit
- Directions to the Clinic
Below are all the forms necessary for your child's appointment with Dr. Thomas. Please download all the forms below, fill out those that need to be filled out, and bring them to your appointment.
- Pediatric Medical History Form
- Finance/Insurance Form
- Office Policies Form
- Informed Consent For Treatment
- Non-Covered Services: Consent for Treatment
- Notice of Privacy Practices
- Getting the Most from Your Medical Visit
- Directions to the Clinic
New Patient - Dr. Piscopo
Below are all the forms necessary for your appointment with Dr. Piscopo. Please download all the forms below, fill out those that need to be filled out, and bring them to your appointment. Also note that there are additional forms, depending on the type of therapy you are doing with Dr. Piscopo, that you will need to fill out and bring to your appointment, in addition to the main forms.
- Medical History Form
- Finance/Insurance Form
- Office Policies Form
- Informed Consent For Treatment
- Frequency Specific Microcurrent Treatment
- Non-Covered Services: Consent for Treatment
- Notice of Privacy Practices
- Getting the Most from Your Medical Visit
- Directions to the Clinic
- If you are seeing Dr. Piscopo for counseling, also include this form.
- If you are seeing Dr. Piscopo for acupuncture, also include this form.
- If you are seeing Dr. Piscopo for FSM/Electrotherapy, also include this form.
PDF files on our website, you need to have a PDF Reader installed on your computer. Please click on one of the options below to download a free copy if you don't already have one.
