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Program in Integrative Medicine

Required Forms

WAIT! Please do not print off any forms until after you have read through the questions and answers in the "Patient Faqs" section of this web page.

Download, print and complete the following forms.

  • New Patient Questionnaire (PDF)
    Please remember to bring your completed questionnaire with you to your first appointment and also bring any recent test results you may have received, or any other information you may think is relevant and is not covered in the questionnaire such as a food diary.

  • Supplements/Medications Questionnaire (PDF)
    Established patients must always bring a copy of their updated Supplemental Medications Form to their follow up appointments.

  • Medical Symptoms Questionnaire (PDF)
    Established patients and new patients are asked to fill out and bring the short symptoms questionnaire to their follow up appointments.

  • Males Only: Testosterone and Health Changes Questionnaire (PDF)