The following forms and corresponding instructions have been provided for your convenience. *Note that the 22 page Client History must be submitted at least one day prior to appointment to allow opportunity for practitioner review.
Please call or email us if you have trouble accessing or completing any form. We are happy to answer any questions you may have.
- Agreement for Wellness Services (done here electronically on our web site, PMA license requirement)
- Disclosure & Informed Consent for Simple Wellness services [PDF]
- FSM Questionnaire [PDF] – VERY Important (2 pages)
- Client History [PDF] – Just do your best to complete, especially matters of Rest, Sleep, Food/Supplements/Meds, Toxins, Stress, Emotions, and Movement.
If you are a new client, please 1st complete the Agreement for Wellness Services electronically on our site (auto Email will confirm signatures), the FSM Questionnaire, our Informed Consent, and Client History forms prior to your first appointment. *There is a $75 charge for ‘no shows’ (cancellations or last minute rescheduling less than 24 Hrs in advance).
Optional: In most cases, it may be valuable for us to review your prior medical records in assessing your current state of health. The following form provides your authorization for our office to request medical records from your present and former healthcare providers.