Intake Forms

Be sure to select the correct form based on the type of care you are looking for​

Standard Intake

Holistic Intake Form - Functional Medicine


Includes a Report of Findings (recommendations

1 hr session

Your choice of either biofeedback scan or and a separate session/phone consult included 

Urine sample may be required

In-office visit or distance friendly

Download form 

Apply for Custom Care

Long Distance Program or Family Plans


Schedule an appointment r discuss what we can offer you based on your needs. 

1 hr sessions

Chinese evaluations

Symptoms Surveys

In-office or distance friendly 

Get Started

 Added Services

Heart Graph, Biofeedback, Reflexology, etc.

Get started for just $65

We offer a variety of stand alone therapies for your choosing 

1 hr session

Select Form

 for your 

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