Forms

New patients/clients: Please complete these intake forms.

After you meet with me for your initial visit, I may ask you to complete other assessment forms as well.

Health History Intake Form

Symptom Assessment Form

Diet & Lifestyle journal week

Health & Toxicity Questionnaire – initial+follow up review form

body pain diagram

Naturopathic Medicine RI Informed Consent/Disclosure :

§ 5-36.1-18. Informed consent and disclosure.

Prior to initiating treatment by a doctor of naturopathy each patient must read and sign a disclosure statement containing the following information:

(1) Rhode Island does not recognize doctors of naturopathy as primary-care providers and a doctor of naturopathy is not responsible for the overall medical care of any patient.
(2) Naturopathic care is intended only as an adjunct to, and not a substitute for, medical care from a physician, physician assistant (PA), or advanced practice registered nurse (APRN), and doctors of naturopathy shall coordinate patient care with physicians and other healthcare providers.
(3) Patients are urged to have a primary-care provider and to have all specialty care provided by a properly credentialed physician specialist.
(4) Doctors of naturopathy are not licensed to prescribe drugs or to advise patients regarding prescription drugs beyond possible dietary supplement/herb – prescription drug interactions. All questions regarding prescription medications should be directed to the prescriber or to the patient’s primary-care provider or licensed registered pharmacist.

History of Section.
(P.L. 2017, ch. 230, § 1; P.L. 2017, ch. 329, § 1.)

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