- The Informed Consent must be read, understood and signed before a patient will be treated at our clinic.
- Some of the forms below are very lengthy, allow enough time to fill them out before coming in to the clinic.
- The General Intake and Informed Consent forms should both be filled out before coming in to be seen as a patient for a first visit.
- Each of the forms may be copied and pasted into Word, filled out on the computer, saved as a file, and emailed.
Form #1: General Intake: Personal History, Past Medical History, Family History, Habits, Diseases, Food, Exercise…
Form #2: Review of Systems: Symptoms in various parts of your body
Form #3: Nutritional Assessment Intake: How does your body respond to various stimuli?
Form #4: Homeopathic Intake: Mental/Emotional response to life?
Form #5: Physical Exam: Areas of the body, how they look, sound, and function
Form #6: Laboratory Tests: Selected tests for internal chemistry indications of health
Form #7: Informed Consent: Ethics, expectations, contracts of performance for Doctor and Patient