Online Forms

Please click the link above to download your forms. All forms must be completed and received by our office 7 days prior to your initial examination.

Please take your time in filling these forms out completely. Some of the questions will seem redundant. You may notice that the same question is asked in different areas of the forms. The reason being; many symptoms can be caused by a number of different mechanisms. This is largely why I don’t treat symptoms, why then I require lab work and why I perform lengthy examinations. Figuring out the mechanism behind the symptom is labor intensive, but it makes my treatments specific and effective.

Adult New Patient Forms

Patient Records Request & Release

New Patient Intake and History

Authorizations and Releases

Adult Metabolic Assessment Form_Electronic

Adult Health Assessment Form_Electronic

Children New Patient Forms

Authorizations and Releases

Child Intake 2011

Child Assessment Electronic PDF

Functional Hemisphere Imbalance Checklist

Patient Records Request & Release

In health,

Dr. Darcy D. Dane