FOR NEW PATIENTS

Preparing for an Intake

 

INITIAL FORMS

Please download and complete these forms for our intake appointment.  MSWord eForms can be forwarded to me electronically or printed and brought to the appointment.


CONTACT INFORMATION - MSWord eForm or PDF 

INITIAL QUESTIONNAIRE - MSWord eFORM or PDF

TREATMENT CONTRACT - PDF

MEDICATION CONSENT - PDF

CONTACT CONSENT/RELEASE - PDF

CREDIT CARD AUTHORIZATION - PDF

PLEASE GATHER YOUR LABS & STUDIES

Please gather all lab reports possible from past doctor's visits.  Even 10-year old labs can be helpful.  Fax, email or Dropbox them to me before our appointment if possible. Or, bring them with you if this isn't possible.

Please Note: Request copies of "labs and Studies" only.  Do not request "your chart" or "medical records."  This is a much bigger request to your provider than is necessary and can delay this process.

HOW MANY VISITS WILL IT TAKE?

A typical work-up, treatment plan initiation and followup generally entails an intake appointment, a follow-up one-hour appointment at 4-6 weeks scheduled after labs and genetics return, and a follow-up hour at 10-12 weeks.  However, each person is different and there may be more time needed in this process.

WILL MY INSURANCE COVER MY VISIT?

I request direct payment for services at the time of service.  I provide a superbill or receipt as requested to allow reimbursement from insurance.

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