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Evaluation Forms for Initial Functional Appointment

 

 

 

                     

                       

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The Medical Symptom Questionnaire

Male Intake Questionnaire

Female Intake Questionnaire

Pediatrics Intake Questionnaire (Age 1-17)

Financial responsibility

Telemedicine Consent

Notice of Privacy Practices

Cancellation Policy

Functional Integrative Program

Working with a functional medicine physician

Frequently Asked Questions

995 Old Eagle School Rd, Suite 311, Wayne, PA, 19087

484-580-6546 

This website is for informational purposes only and is not a substitute for medical advice, diagnosis or treatment.

Information provided on this website is a property of Functional Holistic Healing LLC. We retain the right to amend pricing, policies, or any other information at our sole discretion, without advance notice or liability.

 

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