Patient Forms

If you would like to become a new patient, please download and complete all the forms below. Please email all completed forms to blueridgelymelink@gmail.com. If you have any questions, please feel free to reach out using the contact portal at the bottom of the page.

Please Note: Blue Ridge Lyme Link, LLC is self pay only, and does not have any agreements in place with Medicare, Medicaid or other third party insurers. However, we will provide you with a superbill that you can submit to your insurance company for reimbursement.

Personal Medical History
Financial Agreement
Privacy Policy Waiver
Diagnosis & Treatment Waiver
Symptom Questionnaire
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