To refer a new patient, please fax us this Refer a Patient Form.
If you are already registered with Patient Ally, https://www.patientally.com, you may complete new patient forms via our secure Provider Communications prior to your visit. Otherwise, please print and bring completed “required” forms with you to your 1st appointment.
We look forward to working with you!
To Electronically Submit New Patient Information
1. Log into “Patient Ally” with the Security Code provided to you
2. Enter information to Create an Account
3. Hover over “Document Center” and choose option “Intake Documents””
4. Select your provider “Christina Scribner”
5. Download and Save the Required Documents to your computer
6. Complete each of the Intake Documents
7. Click “Submit” to upload
To Connect with Your Health Provider
1. Log into “Patient Ally”
2. Hover over “My Providers”
3. Select “Provider Communication”
4. Compose a New Message
Policies Demographic Insurance ROI (required)
Insurance Financial Agreement (required)
Assumption Of Risk (required to leave office for walking visit or experientials)
Credit Card/HSA Card Authorization (optional)
Phone: 888-PHR-4ALL (888-747-4255)
Copays are due at the time of your appointment. We accept cash, check, Visa or MasterCard. Credit cards incur an additional 3% merchant processing fee.
We Accept The Following Insurance. Please confirm your medical plan coverage with your insurance provider; “In-network status does not guarantee plan coverage for nutritional therapy.”