Patient Forms


Functional • Integrative • Family Medicine

New Patient Forms

If you would like to become a patient, you will need to fill out the new patient forms, you can begin by selecting the following link: Part One – General History. We know, the forms are lengthily but we are requesting that you fill them out in their entirety so the providers can better serve you. Individuals under 18 years old should fill out the pediatric forms. We will contact you to schedule your new patient appointments. If you prefer to fill out a paper copy, please contact us and we will be happy to mail you a packet or email you one to print off at home. We look forward to meeting you!

New patients are required to have two visits, first visit being a sixty minute visit in which we hear your story and gather the appropriate facts, and get started on a treatment plan.  The second visit is forty-five to sixty minutes, and at this time a physical exam is preformed and initial labs are reviewed. 

Please remember to fill out your 7 Day Diet Log, you can print and bring it to your first visit or fill it out on-line. Please bring in your previous records or labs that pertain to your first visit.

On-line Form Instructions

Please complete each form in the order as listed. You will be automatically directed to the next form after completing and submitting each form. You only need to fill out DATE, DOB and EMAIL on the first form, but you need to fill in your first and last name and email on every form. If you wish to pause after any submission, simply select the next form from where you left off when you return.

PDF Instructions

Adult and Pediatric Patients must fill out (using PDF application or print out and fill out) the following forms prior to your first office visit.