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Forms 

Some of our specialized services - including Iron Infusions and M.I.C. (Methionine, Inositol, Choline) injections - require delegations from other Health Care Practitioners (such as MDs and NPs).

 

Please select a form from the list below to be filled out by the appropriate practitioner and faxed back to the clinic prior to service.

Iron Intravenous Infusion Delegation (MD or NP)

Bring this form to a Medical Doctor or Nurse Practitioner to fill out and fax back to the clinic.

Iron IV Infusion Delegation Form
M.I.C. Intramuscular Injections (MD or NP)

Bring this form to a Medical Doctor or Nurse Practitioner to fill out and fax back to the clinic.

M.I.C. Injection Delegation form

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