Become a Patient

Preparing to Become a Patient

Complete and send all forms below before your appointment through email or fax.


Fax Number: 951-271-4455

Download & Submit Forms

Download the Registration Form here. Please fill out and sign the form and either email or fax it back to us.

Download the Questionnaire here. Please fill it out and either email or fax it back to us.

All patients are encouraged to put together a 1-2 page summary that includes the following information [this is not mandatory but encouraged]:

Family medical history including: Relatives name, relationship, health conditions, age of diagnosis and/or age of death from specific condition. List should include specific types of cancer, heart disease, stroke, GI problems, depression, diabetes, hypertension (high blood pressure), high cholesterol, etc…Family Medical History

Personal medical history with age of diagnosis, procedure, or initiation of medications used for each medical concern. Personal Medical History

Complete list of all medications used in the past as above.

Complete list of all medications used currently. Include dose, medical reason for use and age when started.

Complete list of all supplements presently used. Include dose, medical reason for use, and age when started.

In addition, write out your main goals for the visit or program. What do you want to accomplish in the next 3 months?

Be specific with measurable goals. Download worksheet handout 12 Weeks to Wellness Goals & Strategies.

Know that healing first requires a desire to be healed followed by an understanding of what the body needs for healing to begin. Finally it requires a willingness to follow the path of healing.

Success in all walks of life come to people who are willing to set limits in their private and public lives.

There is an old Jewish proverb,

“Meaning is found in limits”.

Ultimate success if found in limits that are carefully and thoughtfully set.

Download this handout that can motivate and guide you in setting limits now! Click on this link → Success through Setting Limits

Most importantly, during the initial consultations we will likely discuss additional labs that would assist us in establishing your personalized wellness protocol.

To do this please send us any medical reports that include previous diagnosed conditions along with diagnostic ICD-10 codes. Also send us all available labs you have done in the last several years.

Start your health journey with us today!