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INTAKE FORMS

The following forms should be completed prior to your first appointment.
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PLEASE DOWNLOAD AND PRINT THE FORMS BELOW


Intake Forms (PDF)

 

Please download, print, complete and brings these forms to your first appointment.

For questions regarding the completion of forms, please call Diana at: 954-565-4440, ext. 206.

Personal History

Thyroflex Survey

Symptom Sheet

Food Log