Forms and Handouts
New Patients and Natural Health Clients:
Welcome to the Advanced Healing Center of Orange
1. Please print and fill-out all (5) forms under the heading, “Natural Health Forms.”
2. THIS IS VERY IMPORTANT: All of your forms MUST be filled out, COMPLETELY and returned within 3 working days of your new patient appointment. Please include all pertinent reports and/or laboratory tests with your paperwork. A delay in me receiving, beforehand, your forms/tests will most likely take need time away from our consultation/examination. If you arrive without your forms completely filled out, your appointment WILL be rescheduled and you may be subject to a missed appointment fee. Please see form #1 for more details.
“I can only help you to the degree you help me. I will do my part, as a doctor, to the best of my ability, each and every time you come into my office. Please do your part by being on-time and with all of your forms filled out. Thank you in advance, M. Ettinger
Natural Health Forms:
- *Dr. Ettinger’s Fee Schedule 2016
- *Natural Health Informed Consent Form
- *Metabolic Assessment Form
- *Three Day Food Diary (print out just one page if your appointment is within the next 48 hours). Include supplements and medications.
- *BioHealth Diagnostics Survey (men and women, fill out all sections).
Chiropractic New Patient Forms
Additional Forms: (fill out ONLY if requested by Dr. Ettinger)
Becoming a long‐distance patient does not detract from the quality of care. If all of the bases are covered, in the beginning (labs, consultation, history, forms…), then the quality of care and potential outcome are virtually identical to a patient being seen in my office.
Distance Client Program Application, Instructions, Costs:
- Distance Client Application (If for some reason you can’t open the forms on the distance client application, they are all in the “Natural Health Forms” section above, with the red asterisk next to them. You will still need to print out the “Distance Client Application”, fill it out and send it in with all the other applicable forms and tests. Thank you.
- Dr. Ettinger’s Paleo-Work-Book-1-31-12-update-2-2-16 (routinely updated)
- Optimum Consistency and Quality of Poo – Bristol Stool Chart
- Low Glycemic Food List
- Food Guide for Health and Longevity
- Non-GMO Shopping Guide
- Food Combining Chart
- Gluten Free and Gluten Containing Grains
- Lectins in Edible Foods & ABO Blood Type Reactions
- HPA-HPT Axis Chart
- Chronic Stress Response Chart
- Steroidal Hormone Pathway Chart
- High Doses of Antioxidants Including Vitamin C Do Not Decrease the Efficacy of Chemotherapy