iMed
Personalized Medicine

iMed Personalized MedicineiMed Personalized MedicineiMed Personalized Medicine
  • Sign In
  • Create Account

  • Bookings
  • My Account
  • Signed in as:

  • filler@godaddy.com


  • Bookings
  • My Account
  • Sign out

  • Home
  • Services
  • About Us
  • Forms
  • CODES
  • More
    • Home
    • Services
    • About Us
    • Forms
    • CODES

iMed
Personalized Medicine

iMed Personalized MedicineiMed Personalized MedicineiMed Personalized Medicine

Signed in as:

filler@godaddy.com

  • Home
  • Services
  • About Us
  • Forms
  • CODES

Account


  • Bookings
  • My Account
  • Sign out


  • Sign In
  • Bookings
  • My Account

Getting Started

In this page, you will find questionnaires, instructions, and Intake Forms for each type of consult.   

appointment requests

In order to assign the proper tier for your visit, please take the time to send us your narrative.  You will receive scheduling information and instructions about how to best prepare for your initial consultation.

Send Narrative

INTAKE FORMS: For All Consultations

Please complete all intake forms prior to your scheduled visit. 

FORM 2 CREDIT CARD AUTHORIZATION FORM (pdf)Download
FORM 3 REGISTRATION FORM (pdf)Download
FORM 4 CONSENT FORM (pdf)Download
FORM 5 PRACTICE POLICIES (pdf)Download
FORM 6 NOTICE OF NO AFILLIATION TO MEDICARE (pdf)Download
FORM 7 AUTHORIZATION FOR ALTERNATIVE FORMS OF COMMUNICATION (pdf)Download
FORM 8 HIPAA (pdf)Download
FORM 9 REQUEST FOR RELEASE OF MEDICAL RECORDS - PLEASE PRINT ONE PER EACH REQUEST (pdf)Download

GENERAL QUESTIONNAIRES - complete one

IFM ADULT FEMALE INTAKE (pdf)

Download

IFM ADULT MALE INTAKE (pdf)

Download

FORM 23 BRIEF PEDIATRIC HISTORY (pdf)

Download

SELECTED ADDITIONAL QUESTIONNAIRES- COMPLETE AS DIRECTED.

Environmental Sensitivity (pdf)Download
Sleep (pdf)Download
Hormonal History II (pdf)Download
IFM DIET AND FITNESS JOURNAL (pdf)Download
IDentity Stress Assessment (pdf)Download
Hormonal History (pdf)Download
INSTRUCTIONS FOR GATHERING AND ORGANIZING INFORMATION-Binder. For Co (PDF)Download

Download Nutriscript Questionnaire Here

NutriScript Questionnaire (pdf)

Download

FOLLOW-UP FORMS

Please complete this form before each scheduled appointment.

FOLLOW UP FORM (pdf)Download

Are you ready for your visit?

Please make sure to complete and send all forms and pertinent questionnaires at least one week before your appointment.  If you have questions, please email.

Visit Prep Questions

Copyright © 2020 Preventive Medicine Associates, LLC -imed - oakwood, oh.  All Rights Reserved.

  • Services
  • Resources
  • About Us
  • Forms
  • Subscribe
  • Blog
  • Terms of Service
  • Privacy Policy