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 firstname.lastname@example.org. 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 it 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, we'll log in and look at it during our meeting. If you are taking any medications or supplements, you are welcome to bring them so I can see the dosages and ingredients.
Policies and Consent: Please read and familiarize yourself with how my practice works. You can bring a signed copy 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. All records are kept strictly confidential within my practice.