Vizuri Health Center offers our patient application online so you can complete it in the convenience of your own home or office.
New Patient Application Forms - Required
Please click on the link below to access our patient application*. 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 application 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!
*For best results, Internet Explorer is recommended. Please use a desktop computer or ipad (cell phones do not work).