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  • Confidential New Patient Information

  • Please fill out the following forms and submit them to our office at least 2 days before your first appointment.

    We recommend filling these forms out in one sitting as there's not a reliable way to save and come back to an incomplete submission. Allow for 20-30 minutes to complete the entire new patient packet.

    These forms are mobile-friendly, but you may find it more convenient to use a computer with a larger screen and a keyboard.

    Thank you, and we look forward to providing you with excellence in naturopathic healthcare!

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  • Emergency Contact

  • Primary Care Physician

  • List, in order of importance, your major health concerns/what you wish us to address today:

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  • Review of Systems

    Please indicate if you have problems with any of the following:
  • MEN'S HEALTH SECTION:

  • When was your last:

  • WOMEN ONLY: Gynecological and Obstetrical History

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  • Obstetrical History

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  • Sexual History

  • Diet and Health Habits

  • Diet:

  • Exercise:

  • Weight:

  • Sleep:

  • Stress:

  • Thank you for filling out this intake form! We really appreciate this information and will use it to help provide you with the best naturopathic care at your upcoming appointment.

    After submitting this form you will be given an opportunity on the next page to download a PDF copy of your answers for your own records.

    You will also be directed to the next forms to be completed, including our Informed Consent Forms. You will also have a chance to upload any records you may have from other healthcare practitioners.

    Please hit "SUBMIT" to save this form and continue to the next steps.

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