patient intake forms

As the first step toward your healing journey, we need to gather information about your medical history, lifestyle, and current dietary intake. Please complete the health intake forms that pertain to your appointment type. This process should take approximately 1 to 2 hours. Note that you can save these forms and complete them in segments.

We will use the information in these forms to build your in-depth health profile as we work together to identify and address the root cause of disease.

All forms and consents must be submitted to our office at least 7 days prior to all appointments. This is to allow us enough time to input this important information and make sure your nurse is prepared for your conversation.

Functional Medicine
Initial
Consultation
Health Questionnaire 3 Day Diet Diary
Functional Medicine Initial Consultation - Pediatric
Health Questionnaire Addendum 3 Day Diet Diary
Functional Nutrition
Initial
Consultation
Health Questionnaire 3 Day Diet Diary
Follow
up
appointments
Follow up Packet 3 Day Diet Diary