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Natural and Effective Functional and Regenerative Medicine
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PH: 786-306-8009
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Online Forms and Downloads
To Be Completed By All New Patients (1-7)
Online Forms
(Complete and
submit on-line or
print and bring to first
consult)
1.
Nutritional Assessment Questionnaire
2. Burnout Questionnaire
3.
Gluten Sensitivity Questionnaire
NEW
4.
New
Patient Treatment Agreement
Downloadable
Forms
(Complete,
Print, and bring to 1st Appointment)
5.
Insurance Verification Form
6.
Statement of Financial Responsibility
7.
Food Journal for Nutritional
Assesment
8.
Release of Medical Records
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
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
Other Downloads
Affirmations and Visualizations