Forms
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)