New Patient Onboarding

Your first visit begins here.

Complete your intake paperwork before your appointment so we can focus entirely on you when we meet. When you submit, your information is sent securely by email to thrive@balancedhealthnp716.com.

How it works

Fill out the form on this page.
On submit, your default email opens with everything pre-filled.
Send the message — we receive it instantly at thrive@balancedhealthnp716.com.
We'll confirm your appointment by email.

Your privacy

Information is shared only with the Balanced Health care team and handled in accordance with HIPAA. We never sell or share your personal health information.

Prefer email?

You're welcome to write to us directly.

thrive@balancedhealthnp716.com

Personal Information

Full name *Date of birth *Preferred pronounsPhone *Email *Mailing address

Emergency Contact

Name *RelationshipPhone *

Medical HistoryPrimary reason for visit *Current medications & supplementsAllergies (medications, food, environmental)Past medical conditions / surgeriesFamily history (notable conditions)

Lifestyle & Wellness

Sleep (avg hours & quality)Stress level (1–10)

Exercise / movementNutrition / diet patternsAlcohol, tobacco, or other substance use

Your GoalsWhat would feeling well look like for you? *

Services of Interest

Select any that apply.

New Patient VisitEstablished Patient VisitSick / Acute Care VisitIV Nutrient TherapyReikiGut Health Testing (Provider)Gut Health Testing (Basic)Wellness MembershipNutrition / Lifestyle Counseling

Consent & SignatureI consent to evaluation and treatment by Balanced Health.I acknowledge receipt of the Notice of Privacy Practices (HIPAA) and understand how my health information will be used.

Electronic signature (type full name) *Date *

Submitting opens your email app pre-filled and addressed to thrive@balancedhealthnp716.com.

Balanced HealthNurse Practitioner-Led · Orchard Park, NY

A Nurse Practitioner-led concierge practice bringing integrative care — IV therapy, primary care, sick visits, Reiki and gut health — to your door across Western New York, plus telehealth.

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Reach Us

Concierge in-home & telehealth
across Western New York
Mailing:
3221 Southwestern Blvd PMB 104
Orchard Park, NY 14127thrive@balancedhealthnp716.com

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