Healing Place for the Highly Sensitive

Healing is a puzzle, we help you put it together

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New Patient Form

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New Patient Intake Forms

Home | About Us | New Patient Forms | Services and Fee | Contact Us

To contact us:

Phone: (847) 922-4156

Fax: (847) 884-0200

E-mail: harryghong@hotmail.com

New Patient Forms Text Files:

New Patient Form Page 1

New Patient Form Page 2

New Patient Form Page 3

(Allergy/Inflammation Questionnaire)

New Patient Form Page 4

(Candida and Female Questionnaire)

New Patient Form Page 5

(Medication and Supplement Chart)

New Patient Form Page 6

(Cancellation Policy) (signature required)