Online Forms and Downloads
| To Be Completed By All New Patients (1-7) | ||
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Online Forms submit on-line or print and bring to first consult) |
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1. Nutritional Assessment Questionnaire2. Burnout Questionnaire3. Gluten Sensitivity Questionnaire NEW 4. New Patient Treatment Agreement |
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Downloadable
Forms (Complete, Print, and bring to 1st Appointment) |
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5. Insurance Verification Form6. Statement of Financial Responsibility7. Food Journal for Nutritional Assesment8. Release of Medical Records |
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| In addition to above forms: | ||
| To be completed by all Female New Patients | To be completed by all Male New Patients |
To be completed by all
Weight Loss New Patients |
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Female Health Questionnaire Quick Hormonal Evaluation If fertility patient, also Download and Complete Basal Body Temperature Chart Basal Body Temperature Chart (how to use) |
Male Health Questionnaire |
Weight Loss Questionnaire |
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Other Downloads |
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Affirmations and Visualizations |
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