Integrated Care

Request Appointment

Forms

Consent To Treatment
- General Consent Form (All Patients)
- MHK – Integrated Care (MHK Members)
Medical Records Release Forms
Consent To TB/Blood Draw
Consent To IV Therapy

Integrated Care – General Consent Form Download

Full Name

Phone:

How can we care for you?

care Name Email

By submitting this form, I consent to be contacted by Integrated Care LLC and Integrated Care Mental Health LLC (“Integrated Care”) via phone call, text message, and email using the contact information I have provided.

I understand that communications may include appointment scheduling, care coordination, follow-up messages, service-related updates, and other information related to my inquiry or care. I acknowledge that standard messaging and data rates may apply and that consent to receive communications is not a condition of receiving medical treatment or services.

I understand that I may revoke this consent at any time by contacting Integrated Care at 808-738-7671 or team@integrated-care.org.