I Want To Become A Patient

We are grateful that you would like to join The Functional Medicine Center. We kindly ask that you complete the medical intake form to get the process started.

Please allow us 7-10 days to review your intake form. If we decide that we are a mutually good fit, we will ask that you complete a few more forms – the communication policy, the privacy policy and the financial agreement. Then, we will call you to schedule your first appointment.

Choose your intake form using buttons below. For prospective patients over 18, use the adult intake form. For prospective patients under 18, please use the pediatric intake form.

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Adult Intake Form
pediatric Intake Form