PATIENT FORMS
Patient Forms
- Patient Information Sheet
- Adult Intake Questionnaire
- Pediatric Intake Questionnaire
- Request for Medical Records to be Sent to Carolina Center for Restorative Medicine
- Request for Release of Outgoing Medical Records
- Authorization to Use and Disclose Protected Health Information
- Written Acknowledgement of Receipt of Notice of Privacy Practices
Conditions Treated
- Alzheimer’s Disease
- Anti-aging Medicine
- Attention Deficit and Hyperactivity Disorder
- Autism Spectrum Disorder
- Autoimmune Disorders
- Brain Dysfunction and Memory Disorders
- Children with Special Needs
- Chronic Fatigue Syndrome
- Chronic Infections
- Gut Health
- Hormone Imbalances
- Insulin Resistance
- Lyme disease and Associated Tick-Borne Illnesses
- Malnutrition
- Metabolic Syndrome
- Mold Exposure and Neurotoxin Illness
- Metabolic Syndrome
- Neurodegenerative Disorders
- Preconception Care