Online Forms
We offer online forms and registration to all new patients to make your first visit in our office more comfortable and much shorter. You can now download all necessary forms from this page, fill them out in the privacy of your own home, and bring them in on your first visit. Please be advised that not all forms are required or covered during the first visit. The New Member Intake forms are the only required form for your first visit in our office.
To download, click on the PDF icon to the left of the form header. If you need help, please feel free to contact us!
ADULT New Member Health Record
This attachment, in addition to the secure online records, will take care of all of your necessary paperwork for a focused evaluation in our office. Please note this is the ADULT form for new practice members age 18 and older.
CHILD New Member Health Record
This attachment, in addition to the secure online records, will take care of all of your necessary paperwork for a focused evaluation in our office. Please note this is the CHILD’S form for new practice members under age 18.
This is the lifestyle questionnaire required to complete our comprehensive wellness assessment to determine your WQ. Contact us to schedule the rest of your Creating Wellness Assessment!
Symptom Survey & Metabolic Assessment Form
This is a comprehensive survey that assists our practitioners in connecting your symptoms with the underlying problems. By answering a series of questions covering each major organ and endocrine system, our doctors can assist you in finding the right nutritional supplements for you and can make customized lifestyle suggestions to free you from unhealthy patterns that lead to symptoms and dis-ease.
The Candida Survey is for patients going through our wellness evaluation that are dealing with Candida, yeast overgrowth issues, digestive dysfunction, and/or bowel issues.
The Gluten Questionnaire is for patients going through our wellness evaluation that are dealing with inflammatory concerns (asthma, allergies, general inflammation, etc), auto-immune or immune problems, intestinal or digestive issues, food sensitivities, and/or bowel issues. This short, easy questionnaire is the starting point for recognizing gluten sensitivities. For more complete testing, we offer IgG and IgE food sensitivity testing for gluten, wheat, dairy, and over 150 foods and spices.
Enzyme Deficiency Test for Endocrine Dysfunction
The Enzyme Deficiency Test is for patients who have any chronic endocrine dysfunction including but not limited to: upset stomach, constipation, diarrhea, gas, bloating, heart burn, acid reflux, IBD and other bowel disorders, gut and intestinal issues, chronic fatigue, and other digestive issues.
