Integrated Health and Fitness Clinic

A.

Confidential Health Information Questionnaire

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E.

Consent to Email,

Text & Voicemail

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B.

General

Medical History

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F.

Financial Policy

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C.

Integrative Health Policy & Consent to Care Agreement

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D.

Hippa Privacy Policy, Treatment Consent, Claims Processing Consent

1.

Functional

Medicine

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2.

Neurotransmitter Assessment Form (NTAF)

3.

Metabolic

Assessment

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4.

Understanding

Our Goals

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1.

Patient Health Questionnaire – PHQ

5.

Functional Rating Upper Extremity

2.

Patient Follow-up Questionnaire

3.

Functional Rating Neck and Back Index

4.

Functional Rating Lower Extremity

1.

New Patient Intake

2.

New Patient Intake

1.

Terms & Waiver

1.

Release of

Medical Records