3798 Janes Road, #9, Arcata, California 95521, United States

707-599-8677

707-599-8677

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    • Home
    • About Us
    • Clinic Updates
    • Insurance Info
    • New Patients
    • Contact Us
    • Pay Online
  • Home
  • About Us
  • Clinic Updates
  • Insurance Info
  • New Patients
  • Contact Us
  • Pay Online

New Patient Forms


Whether you are a new patient or a former patient of Dr. Breen's, 

we are very happy you found us, and we look forward to helping you feel better soon! 

Please download the NCP Registration package, complete it, and bring it with you to your first appointment.

Included is a welcome letter, a patient registration form, a comprehensive health review form, 

and a consent for treatment.  Please complete the "Patient Acknowledgement to Receive Treatment during COVID-19" form as well.

If you are unable to print the forms, please arrive 15 minutes before your first appointment 

and we will be happy to provide them for you.


Please also download and read:

NCP Financial Policies, Privacy Practices and Patient Rights


Patient Registration Revised 6_22 (pdf)Download
NCP Privacy:pt rights:financial policies (pdf)Download

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