Intake Form & HIPAA Privacy

[vc_row][vc_column][vc_column_text]Thank you for choosing BuildnCare. Please click on the button below and follow these simple instructions:

  1. Click on the Download button below (Blue Button). You must have an updated version of Adobe Acrobat to view and fill in this form.
  2. Fill out the form as best as you can.
  3. Save your document often so you don’t lose your work. Once complete, save it once more and then email it back to us. Please email
  4. You’re done! We’ll be in touch from here.

[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner][vc_btn title=”Download Intake Form Here!” color=”primary” size=”lg” align=”center” link=”||target:%20_blank|”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row]