New Patient Information

New Patient Information

We ask that you download, complete and return the forms listed to the right in person, by fax, or by mail at your earliest convenience. Please sign the ‘Authorization for Release of Medical Information’ below to give to your referring physician or any physician that has treated your chronic conditions in the past and have them fax any pertinent office notes, lab results, scans, and any other test results prior to your appointment. These records are necessary for proper medical diagnosis and treatment and are required prior to your appointment.

Once we receive the forms listed below and your records from any other physician’s office, we will call and schedule your Functional Medicine Consultation.

• Please arrive 15 minutes before your scheduled appointment time.
• Checks, cash, and most major credit cards are accepted.
• If you have any questions, please feel free to call the office at 410-861-5256.
• Our fax number is: 410-861-5258