Pure Wellness Center

Tom Ballard, RN, ND
Scientific Natural Medicine Since 1982

Please download the PDF forms below, print and fill out the Intake and Questionnaire. 

Once you finished, scan and email them to Dr. Ballard at PureWellnessCenters@gmail.com.

To download new patient PDF forms click here

Your answers are an important part of measuring your health status and finding solutions. You will get out of these questions what you put into them. They will seem redundant, but they relate to different processes and systems in your body. Thank you for your help.