New Patient Forms

Please click on the "Clinic Policies and Sample Care Program" button and read carefully. These three pages will explain everything about your care and costs. This is only an example, cost are approximate and may vary. After reading these threee pages and you are interested in becoming a virtual patient, click on the "Intake and Health History Form" button. This will bring you to our online form you can complete and submit.

My primary goal is to be as comprehensive as possible in determining the underlying nutritional, metabolic and neurological issues causing your condition, whether it be fibromyalgia, chronic fatigue, chronic GI issues (IBS, SIBO, GERD) anxiety, brain fog, hypothyroidism, Hashimoto’s disease, autoimmune disorders, etc. To accomplish this, my initial assessment and report of findings occur over two separate visits. This ensures that I have enough time to address all of your concerns. It also allows you time to meet with me and my staff to discover if our clinic is the right fit for you. We have helped patients from all over the country get their lives back. Let us help you as well!

New Patient History Forms

Please download and print out both forms (Health History and Policy) and fill them out completely. Do not leave any blanks. These forms are part of the consultation and you will not be seen if these are not filled out at the time of your scheduled appointment. Thank you for your cooperation.