The Nyerongsha Institute

Patient Forms

If you are already on record as a patient of Dr. Dickey Nyerongsha, please feel free to download any relevant PDF files for your personal use, according to Dr. Nyerongsha's instructions. If you have trouble downloading a file, see "Downloading Tips" below.

Please note that Dr. Dickey is not accepting new patients at this time.

New Patients

(Not available at this time. If you are already a patient on record, please go to the next two sections for available forms.)

If you are visiting with Dr. Dickey for the first time, please complete the following forms and take them to your first appointment:

Current Patients

Herb Orders (current patients only): Please use our Online Order Form for herb refill requests. If for any reason, you aren't able to use the online form, you can download the printed version below and mail it to the address listed there.

General Information

Use this information while continuing your personalized patient care plan:​​​
Downloading Tips
Click on the file you want. A new window will appear displaying the page. Right-click on the page and "Save As." You might get a message asking you where you would like to save the file. If so, select a location and continue.

As an alternative, you can look for the download icon (little page with a down arrow) at the top or bottom of the window. Click on the icon to download.

If it seems like nothing happens, and you don't see the file on your phone or computer, try the following:
  • Use the search function on your computer or phone. The file might have gone to an unexpected place.
  • If you're using Internet Explorer as your web browser, switch to a different application (Firefox, Safari, Chrome, etc.). Also, make sure your browser application is up to date. Older versions of web browsers often don't work properly with current websites.