Dr. Deborah Bernstein - Holistic Healing Center
 

 

FORMS

 

The following are downloadable fill in PDF forms. The forms are required prior to your first visit and take approximately 45 minutes to complete.  Please drop off, mail or e-mail your completed forms to our office prior to your first visit. 

If you choose to e-mail your forms, you will need to save the completed form to your computer as a PDF by right-clicking and choosing “Print.” Then Under “Destination,” change to “Save as PDF,” then click “Save.” After the forms have been saved to your computer, check them to be sure the information saved correctly. Attach the files to an e-mail and send to HHCforms@gmail.com.In order to be on the Priority Waiting List, we must have received your completed forms.

     Preparing for your visit with Dr Bernstein

Patient Consent Form

Office Policies

Medical Symptoms Questionnaire

Adult Medical Questionnaire Part 1

Adult Medical Questionnaire Part 2

Diet Assessment Questionnaire

Three Day Food Journal (Recommended)

The following may be filled out periodically to monitor progress:

Medical Symptoms Questionnaire

Diet Assessment Questionnaire

To prepare for your visit with Audrey Fleck:

          Three Day Food Journal

 

 

 

Lily Pads

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