You will need Adobe Acrobat to open the forms. If you don’t have Adobe Acrobat, get the free download here.
Instructions for Completing Forms
- Click on the link to open the PDF file.
- Save the PDF to your computer by clicking Control + S. This opens a new window that allows you to choose where on your computer to save the file.
- Open the PDF and fill out the editable fields.
- Save and close the document.
- Do the same thing for all other applicable forms.
- When you are ready to submit forms. attach completed forms to an email and send to firstname.lastname@example.org.
Another option is to print and complete the forms, and either mail to our office or bring with you to your appointment.
- Confidential Health History
- Authorization to Release Information
- Privacy Practices
- Consent Agreement - Nutritional Recommendations
- Consent Agreement - Nutritional Therapy and Cancer Care
- Consent Agreement - Phone Consultations
- Female Interim Symptom Questionnaire
- Male Interim Symptom Questionnaire