New Patients

I welcome the opportunity to work together. To make the most of your time, please complete the following patient candidate form. I will review your information within two business cases and recommend next steps. (Mike note – I don’t know what should go here versus valant. Also, based on responses you can automatically redirect someone to other resources)

    Personal Information

    Medical History

    Mental Health History

    Lifestyle Factors

    Substance use

    Emotional and Social Wellness

    Complementary Therapies

    Spiritual and Cultural Background

    Other Specific Questions/Concerns

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