Online Questionnaire Forms






("Appointment Online"
shows availability up to 
30 days in advance.)


NOTE:
(Always use your primary
provider or emergency
department/911 for any
urgent or emergency
medical problems.)


Click on my one-stop
online shop
(
Fullscript)
below
for high-quality
supplements,
20%
discount
for my patients,
for your 
customized
treatment
plan after
appropriate lab
testing
and assessment
.


 
NEW PATIENT PAPERWORK:
Please download and complete these 3 forms before your first visit, and bring with you:
  1. New-Patient Registration
  2. Medical History Questionnaire
  3. 3-Day Diet Diary (fill out as you go rather than from memory at the last minute)
Also, please download Diet for Good Health (your guidelines for healthy eating)


(Please see the 
Health Info page for other handouts and information.)


Medical Symptoms Questionnaire
(You can fill this out ONLINE (so it will automatically calculate your health score), & then print your result for your own records; You can repeat this periodically during your treatment to track your progress.)


SPECIAL QUESTIONNAIRES (only if directed):
 1. Ziem Protocol For Chemical Injuries:
               (toxic exposures or multiple chemical sensitivities)
     (See http://www.chemicalinjury.net/medicalcare.htm for more information)

 2. Chronic Lyme Disease (can mimic Chemical Injury):
               (more likely to fluctuate, move around the body, or change temporarily with antibiotics)
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