Admitting Paperwork

We offer our paperwork online so you can complete it in the convenience of your own home. Here are the essential forms we use and why we need them. Simply download, print, complete and bring them with you. If you don't have Adobe Reader, use the link at the bottom of the page to download and install.

Health History

Confidential Health History

We depend upon this three-page form to collect key information about you, your reason for consulting our office and to identify some of the key physical, mental and chemical stressors that could be affecting your health.

Four Pages

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Symptom Survey

Probably one of the most thorough explorations of symptoms you've ever seen. Some you've probably never thought of. Simply circle the 1 for Mild, the 2 for Moderate and the 3 for Severe. Sure it's 224 questions, but it will take just minutes to complete. When it is, we have a powerful snapshot of your current health.

Three pages. 298 k

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Emotional Survey

These questions delve deeper into the emotional patterns that contribute to self-sabotage in our personal and professional lives. We pose 18 statements. Simply indicate whether the statement seems true, partially true, unlikely to be true or clearly untrue. The good news is, we have technologies to help neutralize and eliminate these all to common emotional patterns. Learn more by watching this 3-minute video.

Two pages 119 k

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Each form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.