We appreciate the confidence and trust you have placed in us by scheduling an appointment with Rational Longevity Medicine & Wellness and we look forward to seeing you. If you are able to complete this paperwork prior to your appointment time please arrive 10-15 minutes prior to your scheduled appointment time to scan your Driver’s License and Insurance Card. For whatever reason, you are unable to print and complete the paperwork, please arrive 30 minutes PRIOR to your appointment time for us to provide you the forms and to ensure you are ready for your appointment. The philosophy of our practice is to best help manage your chronic or current pain symptom. We shall make every effort to see that your experience with Rational Longevity Medicine & Wellness is as comfortable as possible.

Please note that if all of the required information is not completed and with you by your scheduled appointment time, our office staff will have to reschedule for another appointment.

What to send in prior to appointment date

  • If required, referral or authorization from insurance carrier if you have a HMO or Health Select insurance plan

What to bring with you to your first appointment

  • New Patient forms
  • Medical insurance card(s)
  • State or government issued identification (example: driver’s license)
  • Payment for visit (We unfortunately don’t accept checks)

We will be happy to discuss anything with you in an open manner and welcome any questions or concerns you may have. We look forward to seeing you and thank you for allowing us to care for you!

Dr.  Gregory T. Davis, MD & Dr. Kirsten K. Shepard, LMT, DC

New Patient Profile

All new patients are requested to have completed a New Patient Profile form prior to your visit. Please download the forms below and bring them to your first appointment.

New Patient Form
Informed Consent For Care
Authorization for Release of Medical Information*
* Be sure to print and return this form to our office for processing.

You will need Acrobat Reader to open and print the forms. DOWNLOAD IT FREE HERE