NEW PATIENT INFORMATION INTAKE
Please fill in this questionnaire as thoroughly as possible. Things that you might feel are "medically not relevant" can give important information (such as habits, moods, temperament, behavior). Such information might give helpful information about your individual reaction to the illness, and thus help us prescribe the best medication for your problem. Make sure you indicate any recent changes that you have noticed regarding mood, temperament, appetite, sleep patterns, digestion, bowel habits and over all well being.
Upon submission, a licensed physician from our clinic will follow-up with you to finalize the case and to discuss payment options. They will give you guidelines regarding your symptoms, including diet and lifestyle changes. They will make recommendations, if required, for specific diagnostic work and provide you with a prescription for a treatment plan which will be shipped out to you within one business day.
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