Patient Intake Form

Intake & Assessment Forms

All new patients: Please CLICK on and COMPLETE the confidential forms below. All forms must be completed before being seen by Jonathan Glass ND, M.Ac.

Consent Form
Health Ministry Application Form
Patient Intake Form
Dosha Test Form
Neuro Toxic Test

HEC Health & Safety Guidelines

Prior to your appointment at our offices in Concord, please download and sign our updated HEC Health & Safety Guidelines, June 16, 2020 and return it to us by email.