Forms

Printing and filling out the following Health Questionnaire ahead of time will save you time in the office. All files are in PDF format. If you have trouble viewing them, try upgrading to the newest version of Adobe Acrobat Reader.

New Patients

• Health Questionnaire
• Notice of Privacy Practices - HIPAA form
• Refocus Questionnaire

Nutritional Response Testing (NRT) Patients ONLY

• NRT patient information form
• NRT patient orientation
• NRT permission and authorization form
• Symptom Survey form

Fibromyalgia Patients

• Health Questionnaire
• Fibromyalgia Oswestry Questionnaire
• Metabolic Assessment Form
• NTAF Health Questionnaire and Medication History
• Refocus Questionnaire