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All New Patients/Clients

Click the image below: Online Patient Intake Form

 

SCROLL DOWN FOR COLONIC INSTRUCTIONS:

1st Step we need your patient intake from:  https://www.waiverking.com/print/37161  Online Form

 

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After completing the online form please send us a quick email to look for your form.    In this email make sure to provide us with your full name, date of birth, and phone number where we can reach you to make your first appointment. 

 

Please email us at vpgwaves@vpgwaves.com

 

Intake forms are necessary for:

 

1. Acupuncture

2. Cupping/Gua Sha/Tuina/

3. GAINSWave/Shockwave treatments

4. Colon Hyrdo-Therapy

5.  Medical Consultations with a Naturopathic Physician or an APRN

6.  EFT Emotional Freedom Technique, or Nutritional Health Coaching

7. Fascia Blasting Treatment

 

 

For all other services mentioned below, a simple two-page intake form will be provided prior 1st treatment in the office

 

1. Bio-Mat sessions

2. Far Infrared Sauna-Dome

3. Ionic Foot Bath

 

Please make sure to bring in your photo Id to your first appointment. 

 

 

REGARDING:                       Colon Hydrotherapy:

 

1.    Fill out the online form to the right and then send us a quick email letting us know you filled out the form and it is a request for colonics.

 

2.   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. 

 

3.   You will then receive a call or email from our office to confirm that you are approved and to schedule your first appointment.

 

 If you choose an outside physician to fill out your approval "prescription" you still must fully complete our forms.  Click here for VPG Wave's Blank Prescription Form Here

 

OR

 

 A valid doctor's prescription pad must include "approval for a full series of colon hydrotherapy services" and "use as needed." (they may add, any additional comments if they choose.)

 

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Contact Info:  vpgwaves@vpgwaves.com   
Call: (860) 430-2342   Text: (860) 603-3618   Fax: (860) 838-4664

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SHARING IS CARING, PLEASE CONSIDER SHARING THIS INFORMATION WITH OTHERS

Disclaimers:

Alternative Health does not replace the services of your doctor. We offer information along with our products and wellness programs to those who are willing to share responsibility for their own health with their physicians. In the event our patient/client uses this information, and goes off their prescriptions without the approval of a physician, he/she assumes full responsibility for it.

It should not be misconstrued to mean, imply, or indicate that the products or programs described cure anything, as no such claims are made. ONLY THE BODY CAN HEAL ITSELF, so the nutritional supplements are not offered as a cure, but rather as aids to the body in re-establishing normal functions. The body is very complex, and providing a clean diet and one hundred percent nutrition can optimize one’s health. Results may vary.

If your doctor indicates that nutrition is not important and attempts to treat you only with drugs, we suggest you obtain a second opinion from a diet-conscious physician who is more aware of natural methods of biological medicine, because - after all – it is your health!

The statements made about the effects of the dietary supplements/treatments have not been evaluated by the Food and Drug Administration. Dietary and nutritional supplements are intended for special dietary use. They are not intended for use in the treatment, cure, prevention, or mitigation of any disease or disorder. They are intended to be used as part of an overall healthy lifestyle program that includes proper diet and exercise. Only your doctor can properly diagnose and treat any disease or disorder. Before starting to use any nutritional supplement, it is important to check with your doctor.

All statements on this website have not been evaluated by the Food and Drug Administration. These products/services are not intended to diagnose, treat, cure, or prevent any disease.

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