Forms

Please complete these forms at your own convenience and bring them to your first office visit.

Patient_intake_form

Consent_to_treat_form

Insurance Verification Form ***Please verify your insurance if you would like possible reimbursement. Use this form and call your insurance company to understand your out of network benefits.

Daily Food and Activity Diary

Metabolic Assessment Form

Neurological Assessment Form

Childhood Neurological Assessment Form (For children only)

Educational Material:

Gluten Free Booklet

RepairVite Brochure

Intestinal_Repair_Sample_Menu

ClearVite Brochure

ClearVite Program

ClearVite Smoothie Recipes