Forms and Handouts

Welcome to the Advanced Healing Center of Orange 

 

Natural Health Clients

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 outCOMPLETELY 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:

  1. *Dr. Ettinger’s Fee Schedule 2016
  2. *Natural Health Informed Consent Form
  3. *Metabolic Assessment Form
  4. *Three Day Food Diary (print out just one page if your appointment is within the next 48 hours). Include supplements and medications.
  5. *BioHealth Diagnostics Survey (men and women, fill out all sections).
  6. PLEASE READMy Policy on Email and Phone Calls 
  7. PLEASE READ  – NOTICE OF PRIVACY PRACTICES – HIPAA

Chiropractic Patients

Chiropractic Patient Forms

  1. Chiropractic New Patient Form (Print, fill out, and bring in with you)
  2. PLEASE READ  – NOTICE OF PRIVACY PRACTICES – HIPAA
  3. Chiropractic Informed Consent Form (Print, read, and bring in with you “unsigned”)
  4. PLEASE READMy Policy on Email and Phone Calls

Additional Forms: (ONLY if requested by Dr. Ettinger)

Distance Clients:

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 Program (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.
  • Please read my post, “Epigenetics – Why Am I Sick, Why Am I Healthy“, for more understanding on why we have dis-ease or health within the body.
  • PLEASE READMy Policy on Email and Phone Calls 

Office Handouts: