Other Forms Notice of Privacy PracticesThis Privacy Practices notification should be reviewed, but does not need to be printed or brought in with you to your appointment. Expanded Adult Intake FormAn expanded health interview for new adult patients, designed as a secondary, more thorough intake form. Records ReleasePlease fill out this form to release medical records from another facility to our office or to have our office release your records. Records Release, for Origins Natural Medicine (Dr. Alicia’s practice)Origins patients who worked with Dr. Alicia McCubbins should sign this records release prior to their first appointment. Referral FormWanting to refer a patient to Prosper Natural Health? Please fill out this referral form and fax it to us.