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For Functional Health and Clinical Nutrition Counseling

For those interested in becoming a Functional / Integrative Health patient.

When you call our office to schedule your initial Functional Health appointment, our staff will send you an email confirming the date & time of your initial appointment, the paperwork “due date”, and the “Document Open Password”, which you will need in order to open the Functional Medicine intake paperwork packet. When you receive this email, please download the packet from our website, print it out (single-sided), and complete the forms, by hand, using BLUE ink. There is a section of the packet entitled “Health History Summary”; please type this portion, as you will be expected to share a great deal of information. As you go along, you may remember things which you will need to go back and put in…it’s just much easier to type it. The Functional Medicine packet is approximately 30 pages long, in .pdf format.

If you do not receive this email within roughly four hours of speaking with us, check your email’s “spam” filter (just in case the email went there). If it is not, please call our office immediately and our staff will attempt to re-send the information.

It is extremely important that you answer every question; fill in every blank, and check every appropriate box. Please refrain from using the phrase “I don’t know”; take your time, think it over, and give your best answer. The more detailed information that we can gather about you, the more complete and effective your care will be.

This intake packet must be returned to our office, in person, no later than 2-weeks before your initial appointment.

IMPORTANT NOTE…If we do not receive your packet on time, your initial appointment may have to be rescheduled in order to allow the proper and necessary time for the doctors to review your information.

Initial Functional Health Intake Packet (PDF)

For Functional Chiropractic Care

All new general chiropractic patients must complete this intake paperwork packet in full. Please download the packet, print it out (single-sided), and complete all forms in BLUE ink. This paperwork must be completed by the start of your scheduled initial visit. Our office makes every effort to run on time and thus, we cannot accommodate additional time for incomplete packets. If your visit is due to a recent Motor Vehicle Accident, please fill out the Motor Vehicle Accident Form instead.

Initial Chiropractic Intake Packet (PDF)

All new chiropractic patients who have EVER been involved in a major Motor Vehicle Accident, OR ANY Motor Vehicle Accident within the past 7 years, no matter how minor, must fill out a Motor Vehicle Accident form. If you’ve been involved in more than one accident that meets these criteria, please download and complete one form for each accident. These forms give us a good idea of what happened, how to approach treatment, and what sort of outcome we can expect. This paperwork must be completed by the start of your scheduled initial visit.

Motor Vehicle Accident Form (PDF)

If you are seeking Chiropractic, Acupuncture, Medical Massage Therapy, or Ancillary Services due to injuries suffered as a result of a Motor Vehicle Accident, and wish to utilize the Personal Injury Protection (PIP) coverage of your Automotive Insurance policy, please download and complete this form, and return it to our office prior to your first appointment, so that we may verify your coverage.

PIP Information Form (PDF)

For Acupuncture

Initial TCM Intake Packet (PDF)

TCM Evaluation Form (PDF)

For Medical and Integrative/Elective Massage Therapy

Patients receiving Medical Massage Therapy as directed by their doctor as part of their treatment plan do not need to fill out additional massage therapy intake forms.

Clients who would like to receive massage therapy at our clinic may schedule with our therapists, even if you’re not under the care of one of our doctors. Please understand that as we are a doctor’s office; our therapists are highly-trained, and very experienced with goal-oriented problem-solving techniques, which may differ a bit from the typical massage studio or spa setting.

These forms must be completed and submitted to our office before a therapist can see you. This is to allow the therapist a chance to review your information, so that the session can be tailored to your specific needs; this also helps to minimize short-notice cancellation and missed appointments.

Massage Therapy Intake Forms (PDF)