Patient Forms | Fast & Secure Documents Submission

Forms

Please complete applicable forms prior to your first appointment.

Telemedicine / In-Person

Intake Form

General Consent Form

Photo ID Upload

Pre-Visit Questionnaire

IV Therapy

IV Therapy Intake Form

General Consent Form

IV Therapy Consent Form

IV Therapy Order Form*

* Do not complete IV Therapy Order Form until you have been screened to avoid being charged unnecessarily.

Additional Forms

Trigger Point Injection Consent Form

Fusco Care Concierge Membership Signup Form

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