New Patients

Your intake

A thorough intake before your first visit means we spend our time together on you — not on paperwork. It's confidential, encrypted, and takes about 15–20 minutes.

Before you begin

What to have handy

The more complete a picture I have before we meet, the more of our visit we can spend on what actually matters to you. It helps to have a few things nearby before you start:

  • Your medication and supplement bottles — names, doses, and how often you take them.
  • Any recent labs, imaging, or records you'd like me to see (you can upload them at the end).
  • Your pharmacy name and location.
  • A quiet 15–20 minutes — you can be as detailed as you like in the open-ended sections.
Your privacy

This form opens in our secure, encrypted, HIPAA-compliant system — your health information is protected and goes directly to the clinic. Please don't send medical details by regular email or text. In an emergency, call 911.

Ready when you are

The secure intake opens in a new window. You can save and return if you need to step away.

Begin Secure Intake →

Prefer to talk to a person first, or having trouble with the form? Reach the clinic here → or call 317-410-9978.