Dear Prospective Client,

I look forward to working with you. Below is the paperwork to fill out before our session. Telemedicine clients see below. Please fill them out and bring to your appointment, email them to me, or plan to arrive around 15 minutes early to fill them out in the office. If you have any questions about the paperwork or anything else, feel free to call, or we can discuss it before we begin our treatment. I look forward to meeting you soon!

  1. Intake Form
  2. Mandatory Disclosure Statement
  3. Consent Form
  4. Cancellation Policy

Optional Assessments to Consider:

If you feel you have environmental toxicity or want to focus on detoxification please fill out #1 and/or #2 below.

  1. Environmental Toxin Screening- Quick Environmental Exposure and Sensitivity Inventory (QEESI)
  2. Environmental Toxin Involved Questionnaire

Additional information about your appointment: 

Please have something to eat within an hour or 2 before our appointment, wear something comfortable, and please come as fragrance free as possible. If you have singed up for a functional medicine integrative session, please email all lab reports before hand or bring them with you to the visit. 

Telemedicine:

Please fill out these two forms before our visit.
  1. Intake Form
  2. Consent Form
Also please email any lab work, a picture of your tongue using natural light and in focus on the tongue itself, or any other information that you think will be important. I will send a zoom link before the session. If that does not work, please let me know.
Thanks, and please let me know if you have any questions.

Contact Us

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