New Patient Forms

Below is a list of Forms and Documents that will be helpful to bring to your first appointment. 

Forms For Your First Appointment
Please print the following forms and fill out to bring with you to your first appointment. Please also bring any medications or nutritional supplements you are taking.

Confidential Patient Information Form
Terms of Acceptance Form
Disclosure of Healthcare Information Form
Authorization for X-Rays Form
New Dog Patient Form

Questionnaires
Brain Check List
Women’s Hormonal Questionnaire

Health Survey
Take your personal health symptom survey below. This survey will help us identify your overall level of health. We will enter the data into a software program and use your results to plan a strategy to support your health needs for maximum benefits along with the use of the Biofeedback computer program. The use of whole food supplements will optimize your efforts and work. Please click on the below link, print and fill out this form and fax back to us at 910-791-0406 and schedule your appointment today.

Take the Health Survey Now!
Schedule Your Appointment today!