Holistic Functional & Integrative Medicine

Patient Forms

As a new patient you will receive the best of care. We need information from you to get started. In order for your appointment time to be fully devoted to your care and health concerns, we request that you complete all of our forms and return them 4-days prior to your appointment.

Contact us to receive an e-mail with a Health History Questionnaire and a link to our online Waiver signing process. For your convenience we have made them available as hyperlinks below.  

You can scan and email the completed questionnaire back to us or fax it to our HIPAA secure e-Fax: (888) 242-0735. Any questions please call one of our nurses at (800) 965-8482.

Link to Health History Questionnaire

Link to SmartWaiver (Patient Waiver Online Forms)

Hypothyroidism Web Site