Patient Intake Forms « Healing Waters Wellness Center

Patient Intake Forms

Please print out the forms, fill out both forms and bring them with you to your first appointment. These forms are in .PDF format. If they do not open, you may need AdobeReader or an upgrade. To download the latest version of this free program, go to .

(Be sure to un-click any programs you do not want to install such as McAfee Security Scan.)

Confidential Client Information Form

Click Here to open the form. Please print out the form, fill it out and bring it with you to your first appointment.

Clinical Appraiser Indicator Form

Click Here to open the form. Please print out the form, fill it out and bring it with you to your first appointment.

Hours (Washington, DC Time)
Monday-Thursday: 9am-12:30pm, 1:30pm-4:30pm
Friday: 9am-12:30pm
Saturday, Sunday: closed
Other times may be available by special request
Appointment is Required. Office hours alternate between locations.

Phone: 301.824.HEAL (4325)
Email: HealingWaters at myactv.net

Healing Waters Wellness Center
38 East Water Street
PO Box 769
Smithsburg, MD 21783-0769
AND
286 Montevue Lane
Frederick, MD 21702

Health Consultations are available Nation-wide.
Professional-grade supplements can be
shipped to you.

We are only 10 minutes from Hagerstown, MD and now in Frederick, MD!

Healing Waters Wellness Center

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Patient Intake Forms

Confidential Client Information Form

Clinical Appraiser Indicator Form

WE ARE NOW OPEN in FREDERICK, TOO!

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