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

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