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 to 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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