Intake Forms


Your intake form is one of the most important aspects of your program. Please take your time carefully filling out the form and follow the instructions below carefully:

This form must be filled out and saved in Adobe or printed and filled out manually.  DO NOT fill it out in your browser as it WILL NOT SAVE.

  1. Download the form.
  2. Fill it out.
  3. Save the form.
  4. Attache it as a pdf file and email back to us.

If you do not complete the form, please keep your original appointment. You will have a chance to re-submit the form after your consultation.

Take your time telling your story.  The more we know, the better we can help.  If you are not sure how to answer, leave a question mark next to the question. Please do not retype the form as the layout of the form helps us interpret the information.

You may send the filled out form to support@thecarrollinstitute.com once completed or bring it to your consultation.

Please click on the button below to download the intake form.

Take The First Step Today On Your Journey Back To Health

Maybe you have some questions you’d like to ask before you make a decision on becoming a patient. Our patient coordinator is standing by, happy to answer any questions you have to see whether or not The Carroll Institute is right for you.