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.

1. 1. 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. 

      IF YOU DO NOT HAVE PRINTER THEN SKIP STEP #1 AND GO TO #2 BELOW NOW and you can fill these out in the office. 

   2. Holistic Health History Forms are done online, this will take you 20 minutes to complete.  Fill out all the questions on the New Patient Form.  At the end of each form you will be prompted to click the link to go to the “next form”.  There are 3 separate forms that you will fill out and then you will be done.
   3. After you fill out all 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

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.

Contact us for a consult with Dr. Kydonieus to determine which lab Work Up is needed in your case.

• Organic Acids Test for abnormal metabolism markers (home urine collection test)
• Mycotoxin Organic Acids Test (home urine collection test)
• Non-Metal Toxic Chemical Testing (home urine collection test)
• Glyphosate, Urine and house water sample testing
• IgG Food Allergy Testing (blood spot from a finger prick)
• IgE Mold Allergy Testing (blood spot from a finger prick)
• Omega 3:6 Inflammation levels (finger prick, blood spot test)
• Hormone Testing (saliva test is the most accurate)
• Neurotransmitter Testing “brain hormones” (saliva testing)
• Metabolic blood Panel with cholesterol and Vit D3 (traditional blood draw done at LabCorp)