Maranatha Natural Living, LLC

Integrative Family Medicine


Forms to Establish Care
(Please include a copy of your health insurance card front & back)

* Health History (Adult Patients)

* Pediatric Medical History (Pediatric Patients)

* Metabolic Questionnaire

* Stress Assessment

* Treatment Consent Form

* Medical Release Form

* Patient Information

* HIPAA Compliance Patient Consent Form

Complete only if required by healthcare provider

* Adrenal Stress Indicators

* Diet Diary and Exercise Log

* Horowitz Lyme-MSIDS Questionnaire

* Read: Instructions Prior to your first visit (for Functional Medicine Patient Visits)