Contact Holly

To schedule an appointment

please call 727-216-6929

Or E-mail our front office at

countrysideintegratedhealth@gmail.com

28467 US Highway 19 N., Suite 302
Clearwater, FL 33761
Holly@docholly.net

     Brochure

Please complete the following forms and bring them
with you to your first appointment.

• Patient Intake Form
• Patient Consent Form
• Patient Questionnaire
• Prescription Information Form
• Arbitration Agreement and Informed Consent Form
• Appointment Cancellation Policy

Map

Holly Johantgen, DOM, AP
28467 US Highway 19 N.
Suite 302
Clearwater, FL 33761
727-216-6929
www.docholly.net
Holly@docholly.net
Front office: countrysideintegratedhealth@gmail.com