New Patient Forms

Thank you for choosing the office of Dr. Rodney Russell.  We believe you’ll find this to be unlike anything you’ve experienced before when it comes to your health.  Please note that we are a cash practice (cash, credit card, HSA/FSA) and we do not file insurance.  Also, note that we have a 24-hour cancellation policy.  If you must cancel or need to reschedule, we require that you call us 24 hours before your scheduled visit to avoid a cancellation fee.  The fees are noted on the New Patient Inquiry.

DR. RUSSELL – NEW PATIENT INTAKE

The following forms are included in the ABOVE ONLINE NEW PATIENT INTAKE:

NOTICE OF PRIVACY PRACTICE

ARBITRATION & INFORMED CONSENT

COVID-19 LIABILITY WAIVER

The Red Light Therapy form below is only required if you are going to use our Red Light Therapy.

RED / LED LIGHT THERAPY DISCLAIMER

Lab Orders (*call for password)

CASH PAY 

INSURANCE

© Copyright 2021 Natural Healing Center All rights reserved

Dr. Russell provides holistic medicine and wellness services in his North Texas clinic as well as nationwide via phone or video conference.

TEXAS FUNCTIONAL / HOLISTIC MEDICINE

1650 West Northwest Hwy., Suite 103
Grapevine, Texas 76051

(817) 310-0393

*New Patients, please fill out the “NEW PATIENT INQUIRY” and you will be called to answer questions and schedule.

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