Information For Patients

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Information forms and List of questionnaires.

Please print and bring any applicable forms/questionnaires to your visit.

Filling out pertinent items ahead of time helps us use our face-to-face time more efficiently.

Some of them belong to other organizations/practices, but I find them useful for our purposes.

If you have any prior records, it is a good idea to bring them to your visit.

List of thyroid symptoms

Fibromyalgia Questionnaire                                      Lyme questionnaire

Three Day Food Diary

The Age Print Quiz

Endocrine system questionnaire

Adrenal Fatigue Questionnaire

Allergy Questionnaire

Memory Questionnaire

Constipation Questionnaire           Bowel Assessment Patient Questionnaire

Insomnia Screening Questionnaire

For Women 

Menopause Questionnaire (NAMS)              Menopause Rating Scale

Incontinence Questionnaire                           Incontinence Impact Questionnaire

Female Sexual Function Index                       Sexual Satisfaction Survey

Fertility Questionnaire

Hot Flash Assessment scale                             Hormone deficiency test

O SHOT Consent form

PCOS Questionnaire


Metagenics Women’s Health Questionnaire

For Men Only

ADAM Questionnaire plus additional questions                     Andropause Quiz

Male Symptom Questionnaire

Priapus Shot Consent form (“P” Shot)

Andropause article

Male Hormone Questionnaire and Consent


Diet Information Links


The Virgin Diet Quick Start Guide                       The Virgin Diet Cookbook

Virgin diet sugar impact scale                            Virgin Diet, Where Dairy and Gluten hide

Paleo Diet Plan Crossfit Quickstart

Candida Cleanse Guide

GAPS diet overview                                               A guide to being underwhelmed on the GAPS diet

SCD Diet for SIBO

Pounds and Inches Original HCG diet protocol

Miscellaneous Information Links

Fertility strategies

Low Dose Naltrexone          Low Dose Naltrexone info           Low Dose Naltrexone Consent form

Testosterone and the heart


Female Sexual Function

Addyi Pre-Authorization form               Addyi discount card                  Addyi Consent Form

Oxytocin Treatment