KindHealth Clinic Patient Intake Form

General Health Survey

This form is for 1st time KindHealth applicants. 

Complete each step in the health form below. Our representative will reach out to you soon.

Fast. Easy. Care.

Step 1 of 7


After submitting the form above, schedule a an in-person evaluation with our team   

 Your protected health information is always kept confidential, private, and safe. 

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