Welcome to Fern Life Center!
We are honored you chose Fern Life Center and Dr. Keesha Ewers, Functional and Ayurvedic Medicine Practitioner, to be a part of your journey into wellness. In order to serve you better, here is information you will need prior to your first visit.
New patient intake forms
Please bring the following completed forms at the time of your visit. Note that if you just click the links below, the forms will open in your browser and then you can download them. Otherwise, right-click and select "Save Target As" or "Save Link As" to directly download the forms to your computer. Please print and fill them out, and bring them to your appointment.
- FLC New Patient Intake Form
- Laboratory Fees Release Form
- Nutritional Benefits Request Form
- If you are coming in just for a colon hydrotherapy treatment, you only need to fill out the Colon Hydrotherapy (CHT) Intake Form.
- Your insurance card.
- A list of supplements or medications you are currently taking.
- Copies of lab, pathology and diagnostic imaging reports from the last year UNLESS you are a cancer, Hep-C or HIV patient in which case these copies are needed from the date of first diagnosis of these illnesses if possible.
- Please read the HIPAA statement of privacy document. You will be asked to sign attesting that you have read this.
- Please do not bring copies of progress or chart notes
Our cancellation policy
Our time, like yours, is valuable and we require a minimum of 48 hours notice to cancel or reschedule an appointment. If this requirement is not met, you will be charged your full appointment fee.