Forms

New Patient Checklist (Online Form)

New Patient Intake Form (Print Out/Fax)
Please bring the intake form with you to your first visit. It is also helpful to bring copies of past medical records to support your medical history.

Notice of Privacy Practice (info only)
Disclosure of your patient privacy rights.
Read and understand your privacy rights of health and personal information.

Bioidentical Hormone Therapy Consent Form (Print Out/Fax)

Driving Directions & Parking

CONSENT to Release Records/Information:

Release Information TO Akasha Center FROM external source (Online form)
Release Information TO Akasha Center FROM external source [Print Out/Fax]

Release Information FROM Akasha Center TO external source [Print Out/Fax]

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Akasha Center
A Better Way to Get Better.

" I have gone through much of my life, not paying attention to my body and only responding to it when it's in a crisis. As I've aged, I have needed to pay attention to the long game and Dr. de Mello has been my partner in that exploration. He has taught me that numbers don't lie and his extensive testing has helped me see patterns and trends that I never wanted to look at. His focus and care has given me the confidence to know that I can, as we say in recovery "change the things I can.”

Jamie Lee Curtis Actress

"I’ve been going to the Akasha Center for four months and together we’ve been working to create a better, healthier lifestyle that works for my hectic schedule. By sticking to a strict diet and exercise plan, as well as natural remedies and herbal supplements, I’ve lost over 40 pounds. Through hard work and commitment to making this life change, I now have more energy and feel better than ever."

Lee Daniels Director

"I have known Dr. Edison De Mello for many years now. He has proven himself to be an outstanding doctor. His knowledge of integrative medicine is second to none. I was loking for an M.D. who understood both western and eastern medicine and I found it."

Dylan Mcdermott, Actor

"After Dr. De Mello, I found the balance and health I needed. He had a loving approach to understanding my own body. The strength and readiness I feel is due to Dr. de Mello’s treatment. Thanks Dr. D Mello!”

Alice BragaActress