770-720-2222
6199 Hickory Flat Highway
Suite 142
Canton, GA 30115

Patient Forms

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

 

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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

 

 

 

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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

 

 

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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.