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Patient Intake Form

Inspire Health flower

Please complete this form prior to attending your first individual appointment with a clinician at InspireHealth.

Tips for completing the form

  • You can save your form and continue at a later time. Your information is secure and encrypted. Just scroll down and click ‘save and continue later‘. You will then have the option to enter your email to receive a link and continue later.
  • We will not receive the form until you click the submit button at the end of the form. If you prefer, you can download a PDF copy of this form and email it back to us at