UA-164102434-1

Vitalized Performance Group

You may print the patient forms ahead of time. You can fill them out before you come for your appointment or come in 15 minutes prior to your appointment and fill them out in our office.


We appreciate having you fill out the entire form even if you do not foresee yourself having some of the services offered. The more information we have, the better we can find and treat the root cause of the health issue.  


Please bring in any lab work you had done within the last 6 months.  

Patient Forms

 

If possible, please print and complete each page of the form then fax, email or bring with you to your first appointment.



click to print out VPG Intake Form:

Fax: 860-430-2843


Email: [email protected]

 

Snail mail or drop in our mailbox:

212 New London Turnpike, Suite D Glastonbury, CT 06033


[email protected] is a HIPAA COMPLIANT 3RD PARTY ENCRYPTED EMAIL: PLEASE USE THIS EMAIL FOR ALL IMPORTANT AND CONFIDENTIAL EMAILS. ALL PROVIDERS HAVE ACCESS TO THIS EMAIL. We understand that many households use shared e-mail addresses. You give us permission to send emails where others can potentially access the information. With today’s advances in technology and the busy lifestyles that people lead, email is often preferred over other forms of communication when it comes to confirming appointments or sending lab test results. However, patients/clients should be aware that even despite extensive efforts on the part of the healthcare provider to protect sensitive information, no email is 100% safe



Please bring a valid photo ID to your first appointment. 

Colon Hydrotherapy: 

First time clients should first print and complete the patient intake form.  You can return completed forms by using the methods described here.   

Our naturopathic doctor will review your intake form* and make sure receiving colonics is safe for you. This is an annual requirement. You might receive a call to clarify your information if such clarification is necessary. You will then receive a call or email from our office to confirm that you are approved and to schedule your first appointment. 

Even if you chose an outside physician to fill out your approval "prescription" you still must fully complete our forms. 

*There is no additional charge for a VPG Waves provider to review and approve you for our services.