New Patients
To expedite our new patient intake process, the intake forms are available below for you to print and fill out at your convenience. When complete, you can FAX the forms to us at 703-858-3876.
We are considered an out-of-network provider to your insurance carrier, should you have health insurance. On every visit you are provided a "superbill" to submit to your insurance carrier and/or your Health Savings Plan. Please bring your insurance card on your first visit so your electronic superbill will have all accurate information for submission.
Patient Intake Forms
- General Patient Intake
- Child Patient Intake
- Symptom Survey
- Terms of Acceptance
- Nutritional Program Guidelines
- Privacy Policy
- Professional Fee Schedule
Patient Intake Questionnaires
- Adrenal Fatigue Quick Check
- Fibromyalgia/Chronic Fatigue
- Hypothyroid Quick Check
- Male Hormone Quick Check
- Candida Questionnaire
- Toxic Exposure Questionnaire
- Weekly Dietary Log
- Sleep Evaluation
- Iodine Patch Test
- For more information, see Iodine In The Diet, which details clinical research clarifying the role of iodine in the diet. Spefically, see publications 14, 15, and 16.