New Patient Forms

New Patient Forms to be printed and filled out for your first visit with the doctor. Most Popular Programs designed for you and your families health. Look it over and set up your personal appointment. Contact Us.

Resolve 2012 Purify Your Body - Transform Your Life
Standard Process Stress Evaluation Questionaire

Tell us your Problems Now:

All your symptoms relate to a system that is not working because of nutritional and mineral imbalance?
Tell the doctor what is going on with you emotionally, physically, and chemically?

Fill out the complimentary System Survey form: (Online Symptom Survey Version Available November 2012)

Click highlighted links to view or print:

New Patient Intake Information


What are you currently taking?


Substance Survey Form
Let us know what you are eating? Daily Record of Food Intake Form
Learn your toxic metal load for healing. Toxicity Questionnaire Form
Print your list of - Drugs that gobble up vitamins'
Easy home - Candida Test
Your Nutrition Plan Food is Your Most Powerful Medicine