{"id":293,"date":"2021-11-27T21:47:37","date_gmt":"2021-11-27T21:47:37","guid":{"rendered":"https:\/\/medisanhealth.com\/?page_id=293"},"modified":"2022-08-15T17:26:14","modified_gmt":"2022-08-15T17:26:14","slug":"forms","status":"publish","type":"page","link":"https:\/\/medisanhealth.com\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"\n<p><\/p>\n\n\n<style>#kt-layout-id_e4af6b-7b > .kt-row-column-wrap{align-content:start;}:where(#kt-layout-id_e4af6b-7b > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}#kt-layout-id_e4af6b-7b > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:var( --global-content-width, 1800px );padding-left:var(--global-content-edge-padding);padding-right:var(--global-content-edge-padding);padding-top:var( --global-kb-row-default-top, 25px );padding-bottom:var( --global-kb-row-default-bottom, 25px );grid-template-columns:minmax(0, 1fr);}#kt-layout-id_e4af6b-7b > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){#kt-layout-id_e4af6b-7b > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){#kt-layout-id_e4af6b-7b > .kt-row-column-wrap{padding-bottom:8px;grid-template-columns:minmax(0, 1fr);}}<\/style>\n<div class=\"wp-block-kadence-rowlayout alignnone\"><div id=\"kt-layout-id_e4af6b-7b\" class=\"kt-row-layout-inner kt-layout-id_e4af6b-7b\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-gutter-default kt-v-gutter-default kt-row-valign-top kt-row-layout-equal kt-tab-layout-inherit kt-m-colapse-left-to-right kt-mobile-layout-row kb-theme-content-width\"><style>.kadence-column_0c7ddc-60 > .kt-inside-inner-col{border-top-width:0px;border-right-width:0px;border-bottom-width:0px;border-left-width:0px;}.kadence-column_0c7ddc-60 > .kt-inside-inner-col,.kadence-column_0c7ddc-60 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column_0c7ddc-60 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column_0c7ddc-60 > .kt-inside-inner-col{flex-direction:column;}.kadence-column_0c7ddc-60 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column_0c7ddc-60 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column_0c7ddc-60{position:relative;}@media all and (max-width: 1024px){.kadence-column_0c7ddc-60 > .kt-inside-inner-col{flex-direction:column;}}@media all and (max-width: 767px){.kadence-column_0c7ddc-60 > .kt-inside-inner-col{flex-direction:column;}}<\/style>\n<div class=\"wp-block-kadence-column inner-column-1 kadence-column_0c7ddc-60\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading_1d18b2-ad, .wp-block-kadence-advancedheading.kt-adv-heading_1d18b2-ad[data-kb-block=\"kb-adv-heading_1d18b2-ad\"]{font-size:45px;font-style:normal;color:#215387;}.wp-block-kadence-advancedheading.kt-adv-heading_1d18b2-ad mark, .wp-block-kadence-advancedheading.kt-adv-heading_1d18b2-ad[data-kb-block=\"kb-adv-heading_1d18b2-ad\"] mark{font-style:normal;color:#f76a0c;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}@media all and (max-width: 767px){.wp-block-kadence-advancedheading.kt-adv-heading_1d18b2-ad, .wp-block-kadence-advancedheading.kt-adv-heading_1d18b2-ad[data-kb-block=\"kb-adv-heading_1d18b2-ad\"]{font-size:30px;text-align:center!important;}}<\/style>\n<h2 class=\"kt-adv-heading_1d18b2-ad wp-block-kadence-advancedheading\" data-kb-block=\"kb-adv-heading_1d18b2-ad\">New Patient Forms<\/h2>\n<\/div><\/div>\n<\/div><\/div><\/div>\n\n\n<style>#kt-layout-id_e1bfa9-d6 > .kt-row-column-wrap{align-content:start;}:where(#kt-layout-id_e1bfa9-d6 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}#kt-layout-id_e1bfa9-d6 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:var( --global-content-width, 1800px );padding-left:var(--global-content-edge-padding);padding-right:var(--global-content-edge-padding);padding-top:var( --global-kb-row-default-top, 25px );padding-bottom:var( --global-kb-row-default-bottom, 25px );padding-bottom:0px;grid-template-columns:repeat(3, minmax(0, 1fr));}#kt-layout-id_e1bfa9-d6 > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){#kt-layout-id_e1bfa9-d6 > .kt-row-column-wrap{grid-template-columns:repeat(3, minmax(0, 1fr));}}@media all and (max-width: 767px){#kt-layout-id_e1bfa9-d6{margin-bottom:100px;}#kt-layout-id_e1bfa9-d6 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style>\n<div class=\"wp-block-kadence-rowlayout alignnone\"><div id=\"kt-layout-id_e1bfa9-d6\" class=\"kt-row-layout-inner kt-layout-id_e1bfa9-d6\"><div class=\"kt-row-column-wrap kt-has-3-columns kt-gutter-default kt-v-gutter-default kt-row-valign-top kt-row-layout-equal kt-tab-layout-inherit kt-m-colapse-left-to-right kt-mobile-layout-row kb-theme-content-width\"><style>.kadence-column_34476a-82 > .kt-inside-inner-col{border-top-width:0px;border-right-width:0px;border-bottom-width:0px;border-left-width:0px;}.kadence-column_34476a-82 > .kt-inside-inner-col,.kadence-column_34476a-82 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column_34476a-82 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column_34476a-82 > .kt-inside-inner-col{flex-direction:column;}.kadence-column_34476a-82 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column_34476a-82 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column_34476a-82{position:relative;}@media all and (max-width: 1024px){.kadence-column_34476a-82 > .kt-inside-inner-col{flex-direction:column;}}@media all and (max-width: 767px){.kadence-column_34476a-82 > .kt-inside-inner-col{flex-direction:column;}}<\/style>\n<div class=\"wp-block-kadence-column inner-column-1 kadence-column_34476a-82\"><div class=\"kt-inside-inner-col\"><style>#kt-info-box_d31157-f8 .kt-blocks-info-box-link-wrap{border-color:var(--global-palette9, #ffffff);background:var(--global-palette9, #ffffff);padding-top:var(--global-kb-spacing-xs, 1rem);padding-right:var(--global-kb-spacing-xs, 1rem);padding-bottom:var(--global-kb-spacing-xs, 1rem);padding-left:var(--global-kb-spacing-xs, 1rem);}#kt-info-box_d31157-f8 .kt-blocks-info-box-link-wrap:hover{border-color:var(--global-palette8, #F7FAFC);background:var(--global-palette8, #F7FAFC);}#kt-info-box_d31157-f8 .kadence-info-box-icon-container .kt-info-svg-icon, #kt-info-box_d31157-f8 .kt-info-svg-icon-flip, #kt-info-box_d31157-f8 .kt-blocks-info-box-number{font-size:50px;}#kt-info-box_d31157-f8 .kt-blocks-info-box-media{color:var(--global-palette1, #3182CE);border-top-width:0px;border-right-width:0px;border-bottom-width:0px;border-left-width:0px;padding-top:10px;padding-right:10px;padding-bottom:10px;padding-left:10px;}#kt-info-box_d31157-f8 .kt-blocks-info-box-media-container{margin-top:0px;margin-right:15px;margin-bottom:0px;margin-left:15px;}#kt-info-box_d31157-f8 .kt-blocks-info-box-link-wrap:hover .kt-blocks-info-box-media{color:var(--global-palette1, #3182CE);}#kt-info-box_d31157-f8 .kt-infobox-textcontent h3.kt-blocks-info-box-title{color:var(--global-palette5, #4A5568);font-weight:600;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;margin-top:5px;margin-right:0px;margin-bottom:10px;margin-left:0px;}#kt-info-box_d31157-f8 .kt-infobox-textcontent .kt-blocks-info-box-text{color:var(--global-palette6, #718096);}#kt-info-box_d31157-f8 .kt-blocks-info-box-learnmore{background:transparent;border-width:0px 0px 0px 0px;padding-top:4px;padding-right:8px;padding-bottom:4px;padding-left:8px;margin:10px 0px 10px 0px;}#kt-info-box_d31157-f8 .kt-blocks-info-box-link-wrap{box-shadow:0px 20px 33px 28px var(--global-palette7, #EDF2F7);}#kt-info-box_d31157-f8 .kt-blocks-info-box-link-wrap:hover{box-shadow:0px 0px 14px 0px rgba(0, 0, 0, 0.2);}<\/style>\n<div id=\"kt-info-box_d31157-f8\" class=\"wp-block-kadence-infobox\"><a class=\"kt-blocks-info-box-link-wrap info-box-link kt-blocks-info-box-media-align-top kt-info-halign-center\" href=\"https:\/\/medisanhealth.com\/wp-content\/uploads\/2021\/11\/New-Patient-Form.pdf\"><div class=\"kt-blocks-info-box-media-container\"><div class=\"kt-blocks-info-box-media kt-info-media-animate-none\"><div class=\"kadence-info-box-icon-container kt-info-icon-animate-none\"><div class=\"kadence-info-box-icon-inner-container\"><span style=\"display:block;justify-content:center;align-items:center\" class=\"kt-info-svg-icon kt-info-svg-icon-fe_fileText\"><svg style=\"display:inline-block;vertical-align:middle\" viewBox=\"0 0 24 24\" height=\"50\" width=\"50\" fill=\"none\" stroke=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" aria-hidden=\"true\"><path d=\"M14 2H6a2 2 0 0 0-2 2v16a2 2 0 0 0 2 2h12a2 2 0 0 0 2-2V8z\"><\/path><polyline points=\"14 2 14 8 20 8\"><\/polyline><line x1=\"16\" y1=\"13\" x2=\"8\" y2=\"13\"><\/line><line x1=\"16\" y1=\"17\" x2=\"8\" y2=\"17\"><\/line><polyline points=\"10 9 9 9 8 9\"><\/polyline><\/svg><\/span><\/div><\/div><\/div><\/div><div class=\"kt-infobox-textcontent\"><h3 class=\"kt-blocks-info-box-title\">New Patient History Form<\/h3><p class=\"kt-blocks-info-box-text\"><\/p><\/div><\/a><\/div>\n<\/div><\/div>\n\n\n<style>.kadence-column_72e206-ab > .kt-inside-inner-col{border-top-width:0px;border-right-width:0px;border-bottom-width:0px;border-left-width:0px;}.kadence-column_72e206-ab > .kt-inside-inner-col,.kadence-column_72e206-ab > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column_72e206-ab > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column_72e206-ab > .kt-inside-inner-col{flex-direction:column;}.kadence-column_72e206-ab > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column_72e206-ab > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column_72e206-ab{position:relative;}@media all and (max-width: 1024px){.kadence-column_72e206-ab > .kt-inside-inner-col{flex-direction:column;}}@media all and (max-width: 767px){.kadence-column_72e206-ab > .kt-inside-inner-col{flex-direction:column;}}<\/style>\n<div class=\"wp-block-kadence-column inner-column-2 kadence-column_72e206-ab\"><div class=\"kt-inside-inner-col\"><style>#kt-info-box_eaf518-41 .kt-blocks-info-box-link-wrap{border-color:var(--global-palette9, #ffffff);background:var(--global-palette9, #ffffff);padding-top:var(--global-kb-spacing-xs, 1rem);padding-right:var(--global-kb-spacing-xs, 1rem);padding-bottom:var(--global-kb-spacing-xs, 1rem);padding-left:var(--global-kb-spacing-xs, 1rem);}#kt-info-box_eaf518-41 .kt-blocks-info-box-link-wrap:hover{border-color:var(--global-palette8, #F7FAFC);background:var(--global-palette8, #F7FAFC);}#kt-info-box_eaf518-41 .kadence-info-box-icon-container .kt-info-svg-icon, #kt-info-box_eaf518-41 .kt-info-svg-icon-flip, #kt-info-box_eaf518-41 .kt-blocks-info-box-number{font-size:50px;}#kt-info-box_eaf518-41 .kt-blocks-info-box-media{color:var(--global-palette1, #3182CE);border-top-width:0px;border-right-width:0px;border-bottom-width:0px;border-left-width:0px;padding-top:10px;padding-right:10px;padding-bottom:10px;padding-left:10px;}#kt-info-box_eaf518-41 .kt-blocks-info-box-media-container{margin-top:0px;margin-right:15px;margin-bottom:0px;margin-left:15px;}#kt-info-box_eaf518-41 .kt-blocks-info-box-link-wrap:hover .kt-blocks-info-box-media{color:var(--global-palette1, #3182CE);}#kt-info-box_eaf518-41 .kt-infobox-textcontent h3.kt-blocks-info-box-title{color:var(--global-palette5, #4A5568);font-weight:600;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;margin-top:5px;margin-right:0px;margin-bottom:10px;margin-left:0px;}#kt-info-box_eaf518-41 .kt-infobox-textcontent .kt-blocks-info-box-text{color:var(--global-palette6, #718096);}#kt-info-box_eaf518-41 .kt-blocks-info-box-learnmore{background:transparent;border-width:0px 0px 0px 0px;padding-top:4px;padding-right:8px;padding-bottom:4px;padding-left:8px;margin:10px 0px 10px 0px;}#kt-info-box_eaf518-41 .kt-blocks-info-box-link-wrap{box-shadow:0px 20px 33px 28px var(--global-palette7, #EDF2F7);}#kt-info-box_eaf518-41 .kt-blocks-info-box-link-wrap:hover{box-shadow:0px 0px 14px 0px rgba(0, 0, 0, 0.2);}<\/style>\n<div id=\"kt-info-box_eaf518-41\" class=\"wp-block-kadence-infobox\"><a class=\"kt-blocks-info-box-link-wrap info-box-link kt-blocks-info-box-media-align-top kt-info-halign-center\" href=\"https:\/\/medisanhealth.com\/wp-content\/uploads\/2021\/11\/Pharmanet-Form.pdf\"><div class=\"kt-blocks-info-box-media-container\"><div class=\"kt-blocks-info-box-media kt-info-media-animate-none\"><div class=\"kadence-info-box-icon-container kt-info-icon-animate-none\"><div class=\"kadence-info-box-icon-inner-container\"><span style=\"display:block;justify-content:center;align-items:center\" class=\"kt-info-svg-icon kt-info-svg-icon-fas_pills\"><svg style=\"display:inline-block;vertical-align:middle\" viewBox=\"0 0 576 512\" height=\"50\" width=\"50\" fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" aria-hidden=\"true\"><path d=\"M112 32C50.1 32 0 82.1 0 144v224c0 61.9 50.1 112 112 112s112-50.1 112-112V144c0-61.9-50.1-112-112-112zm48 224H64V144c0-26.5 21.5-48 48-48s48 21.5 48 48v112zm139.7-29.7c-3.5-3.5-9.4-3.1-12.3.8-45.3 62.5-40.4 150.1 15.9 206.4 56.3 56.3 143.9 61.2 206.4 15.9 4-2.9 4.3-8.8.8-12.3L299.7 226.3zm229.8-19c-56.3-56.3-143.9-61.2-206.4-15.9-4 2.9-4.3 8.8-.8 12.3l210.8 210.8c3.5 3.5 9.4 3.1 12.3-.8 45.3-62.6 40.5-150.1-15.9-206.4z\"><\/path><\/svg><\/span><\/div><\/div><\/div><\/div><div class=\"kt-infobox-textcontent\"><h3 class=\"kt-blocks-info-box-title\">Pharmanet Form<\/h3><p class=\"kt-blocks-info-box-text\"><\/p><\/div><\/a><\/div>\n<\/div><\/div>\n\n\n<style>.kadence-column_c55da8-8a > .kt-inside-inner-col{border-top-width:0px;border-right-width:0px;border-bottom-width:0px;border-left-width:0px;}.kadence-column_c55da8-8a > .kt-inside-inner-col,.kadence-column_c55da8-8a > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column_c55da8-8a > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column_c55da8-8a > .kt-inside-inner-col{flex-direction:column;}.kadence-column_c55da8-8a > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column_c55da8-8a > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column_c55da8-8a{position:relative;}@media all and (max-width: 1024px){.kadence-column_c55da8-8a > .kt-inside-inner-col{flex-direction:column;}}@media all and (max-width: 767px){.kadence-column_c55da8-8a > .kt-inside-inner-col{flex-direction:column;}}<\/style>\n<div class=\"wp-block-kadence-column inner-column-3 kadence-column_c55da8-8a\"><div class=\"kt-inside-inner-col\"><style>#kt-info-box_c0e17f-0c .kt-blocks-info-box-link-wrap{border-color:var(--global-palette9, #ffffff);background:var(--global-palette9, #ffffff);padding-top:var(--global-kb-spacing-xs, 1rem);padding-right:var(--global-kb-spacing-xs, 1rem);padding-bottom:var(--global-kb-spacing-xs, 1rem);padding-left:var(--global-kb-spacing-xs, 1rem);}#kt-info-box_c0e17f-0c .kt-blocks-info-box-link-wrap:hover{border-color:var(--global-palette8, #F7FAFC);background:var(--global-palette8, #F7FAFC);}#kt-info-box_c0e17f-0c .kadence-info-box-icon-container .kt-info-svg-icon, #kt-info-box_c0e17f-0c .kt-info-svg-icon-flip, #kt-info-box_c0e17f-0c .kt-blocks-info-box-number{font-size:50px;}#kt-info-box_c0e17f-0c .kt-blocks-info-box-media{color:var(--global-palette1, #3182CE);border-top-width:0px;border-right-width:0px;border-bottom-width:0px;border-left-width:0px;padding-top:10px;padding-right:10px;padding-bottom:10px;padding-left:10px;}#kt-info-box_c0e17f-0c .kt-blocks-info-box-media-container{margin-top:0px;margin-right:15px;margin-bottom:0px;margin-left:15px;}#kt-info-box_c0e17f-0c .kt-blocks-info-box-link-wrap:hover .kt-blocks-info-box-media{color:var(--global-palette1, #3182CE);}#kt-info-box_c0e17f-0c .kt-infobox-textcontent h3.kt-blocks-info-box-title{color:var(--global-palette5, #4A5568);font-weight:600;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;margin-top:5px;margin-right:0px;margin-bottom:10px;margin-left:0px;}#kt-info-box_c0e17f-0c .kt-infobox-textcontent .kt-blocks-info-box-text{color:var(--global-palette6, #718096);}#kt-info-box_c0e17f-0c .kt-blocks-info-box-learnmore{background:transparent;border-width:0px 0px 0px 0px;padding-top:4px;padding-right:8px;padding-bottom:4px;padding-left:8px;margin:10px 0px 10px 0px;}#kt-info-box_c0e17f-0c .kt-blocks-info-box-link-wrap{box-shadow:0px 20px 33px 28px var(--global-palette7, #EDF2F7);}#kt-info-box_c0e17f-0c .kt-blocks-info-box-link-wrap:hover{box-shadow:0px 0px 14px 0px rgba(0, 0, 0, 0.2);}<\/style>\n<div id=\"kt-info-box_c0e17f-0c\" class=\"wp-block-kadence-infobox\"><a class=\"kt-blocks-info-box-link-wrap info-box-link kt-blocks-info-box-media-align-top kt-info-halign-center\" href=\"https:\/\/medisanhealth.com\/wp-content\/uploads\/2022\/08\/Initial-MVA-Form.pdf\"><div class=\"kt-blocks-info-box-media-container\"><div class=\"kt-blocks-info-box-media kt-info-media-animate-none\"><div class=\"kadence-info-box-icon-container kt-info-icon-animate-none\"><div class=\"kadence-info-box-icon-inner-container\"><span style=\"display:block;justify-content:center;align-items:center\" class=\"kt-info-svg-icon kt-info-svg-icon-fas_car\"><svg style=\"display:inline-block;vertical-align:middle\" viewBox=\"0 0 512 512\" height=\"50\" width=\"50\" fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" aria-hidden=\"true\"><path d=\"M499.99 176h-59.87l-16.64-41.6C406.38 91.63 365.57 64 319.5 64h-127c-46.06 0-86.88 27.63-103.99 70.4L71.87 176H12.01C4.2 176-1.53 183.34.37 190.91l6 24C7.7 220.25 12.5 224 18.01 224h20.07C24.65 235.73 16 252.78 16 272v48c0 16.12 6.16 30.67 16 41.93V416c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32v-32h256v32c0 17.67 14.33 32 32 32h32c17.67 0 32-14.33 32-32v-54.07c9.84-11.25 16-25.8 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