NEW CLIENT FORMS
Click on the green links to access the online Intake questionnaire within my friendly scheduling system and download PDF versions of each form.
New Client Intake: Access the convenient online scheduling system to create a client account and complete the Intake questionnaire. Please allow 15-20 minutes. You can save answers and go back and edit as needed. Or, use this PDF New Client Intake form, scan and email it to email@example.com. In either case, kindly complete the Intake questionnaire 48 hours in advance of our meeting so I can review and start formulating your plan. This helps maximize the value of our time together. If we are meeting on a Monday, it would appreciate receiving your questionnaire by Friday morning at the latest.
Food Journal: Please record what and when you eat and drink for at least 3 days and bring a paper copy to our meeting. Ideally, record two days of regular weekday eating and one day of weekend eating. If you are tracking your food online or keep a journal in another format, that’s fine too, but please find a way to print it so I can keep a file with your Intake questionnaire. If you are taking any medications or supplements, you are welcome to bring them so I can see the dosages and ingredients.
Consent, Policies & Service Menu: Please read and familiarize yourself with how my practice works and how services are priced. I have fine-tuned my policies and services over the years to be as fair and transparent to both you and me as possible. You can bring a signed copy of this document to our first meeting or complete it in person with me.
Records Release Authorization: As needed, you can download this form to give to your doctor to permit them to share health records with me. If you prefer, give the completed form to me and I’ll fax it to your doctor. All records are kept strictly confidential within my practice.