Patient Forms
Becoming a Patient is Simple
First visit, New Patient Exam is $250. Must be prepaid over the phone when you make your appointment.
The exam does not include any treatment but you can be adjusted if the doctor feels it is appropriate on you exam day for the usual adjustment/therapy fee in addition the exam fee.

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IF YOU DO NOT HAVE PRINTER THEN SKIP THIS STEP AND GO TO #2 BELOW NOW. IF you have a PRINTER then Download and print out the Administration Forms by clicking on the highlighted link. Make sure they are completely filled out and signed and bring them in with you on your appointment.
- Click HERE to to fill out your Health History Forms online. New Patient Form site.
- After you fill out your 3 forms online you should call the office to arrange your first appointment for your exam with the doctor. Call now 434-481-2012
- Come in 15 minutes early for your first appointment
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If you are a TeleHealth Patient (online video consultation appointments) ALSO fill out the TeleHealth Consent Form here.
Other Patient Forms and Downloads
- Diet Diary Forms -1 Week for download
- Blood Test List download. If you want your medical doctor to order the tests for our doctor to review
- 147 Sugar Diseases
- Nutrition Response Testing Explained
- Annual Wellness Membership Agreement
- Personal Stress Questionnaire, PDF format
- the Symptom Survey Form and Personal Stress From link comes at the end, be sure to click the link and fill out that last form.