6199 Hickory Flat Highway
Suite 142
Canton, GA 30115

Patient Forms


Click below to download our new patient forms.
Fill out these forms at home before you come for your first visit and save time!


Adult Forms

New Patient Form ADULT

Health History Questionnaire ADULT

Consent for Treatment ADULT

Informed Consent to Care ADULT

Open Adjusting Consent ADULT

Terms of Acceptance ADULT





Children's Forms

New Patient Form CHILD

Health History Questionnaire CHILD

BioChart CHILD

Consent for Treatment CHILD

Informed Consent to Care CHILD

Open Adjusting Consent CHILD

Terms of Acceptance CHILD




Functional Blood Chemistry/Nutritional Consultation Forms

Child Neurotransmitter & Nutrition Questionnaire

Metabolic Assessment

Health Questionnaire




Ready to get started on the path to wellness? Contact Us for to schedule your first visit.