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FORMS

Consultation Forms Instructions

1. Please print and complete the five (5) forms below.

2. All forms must be filled out and brought to your new patient appointment. If possible, please scan and email the forms/labs/tests beforehand to sibodoctor @ gmail.com

3. Please use the calculator below to give me an idea of how well you’re treating your gut microbes. I will use your score to help me better help you achieve your digestive goals.

Please write your score on one of your forms or email it to me at sibodoctor[@]gmail.com

4. THIS IS VERY IMPORTANT: If you arrive without your completed forms, your appointment WILL be rescheduled, and you may be subject to a missed appointment fee.

Natural Health Forms

  1. Policies and Fees: Please read every policy thoroughly. Don’t just initial this document without reading it thoroughly.
  2. Credit Card Authorization Form
  3. Health Consultant Status Form
  4. Metabolic Assessment Form
  5. Three-Day Food Log (Print out just one page if your appointment is within the next 48 hours). Include ALL supplements and medications.
  6. You DO NOT need to print this form unless you would like a copy for your records. I am required by law to provide this to you. These are your privacy rights as a patient. Digestion Coach Notice of Privacy Practices – HIPPA.

Gut Microbiome Calculator