Intake Forms

* Intake forms are available on-line for clients to print and complete at your convenience  prior to your Serenity service.

If you do not wish to complete your intake form prior to arrival, please inform the receptionist when you are scheduling your appointment that you prefer to arrive 10 minutes early to complete the necessary paperwork on site at Serenity.

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ALL New Serenity Clients/ALL Services

Serenity General Intake Form

In addition to the Serenity Intake Form,  please complete the following intake form(s) depending on the service(s) you will be receiving.

Colonic Hydrotherapy Intake Form (Colon Hydrotherapy)

INTAKE FORMS AND INSTRUCTIONS FOR BOTOX/JUVIDERM APPOINTMENTS WITH DR. KIBA:

Aesthetic Health History Form (Botox & Fillers)

Botox Pre-Treatment Instructions (Botox)

Facial Filler Pre-Treatment Instructions (Fillers)

INTAKE FORMS AND INSTRUCTIONS FOR FUNCTIONAL MEDICINE APPOINTMENTS WITH DR. KIBA

Health History Form (ONLY clients seeing Dr. Kiba for a Functional Medicine appointment need to complete this form.)

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*All other services will only require the completion of the Serenity intake form. Upon each client visit, an on-site consultation with the therapist will take place prior to treatment. This protocol helps us to collect up-to-date health information to ensure that the Serenity therapist can best meet each client’s individual and current needs.

Thank you!

Serenity Health & Wellness Center

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