Forms and Handouts

Welcome to the Advanced Healing Center of Orange 

“Death is certain, but life is not. In life, the only thing we have control over is our character and the choices we make. You either pay a biologic toll because of your choices, or you gain a biologic benefit because of your choices.” Dr. Marcus Ettinger

Natural Health Consultation Forms

1. Please print and fill out the first (4) forms under the heading, “Natural Health Forms.” Form #5 is your privacy rights as a patient. 

2. THIS IS VERY IMPORTANT: All of your forms MUST be filled out, COMPLETELY, and brought with you to your new patient appointment. If possible, please scan and email the forms/labs/test as soon as you have them available – info ( @ ) advancedhealing ( . ) com. Also, please bring all pertinent reports and/or laboratory tests with your paperwork. If you arrive without your forms completely filled out, your appointment WILL be rescheduled and you may be subject to a missed appointment fee.

Natural Health Forms:

  1. *Policies and Fees  Please read every policy thoroughly. Do not just initial this document w/o reading it thoroughly. I am a one-man show and I need to enforce every policy, if violated, to keep the practice running smoothly.  
  2. *Health Consultant Status 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 ALL supplements and medications.
  5. *YOU DO NOT NEED TO PRINT THIS OUT. NOTICE OF PRIVACY PRACTICES – HIPAA. I am required by law that I offer this to you. These are your privacy rights as a patient. 

This is for Office Use Only. DO NOT PRINT THIS FORM. COMMUNICATION POLICIES UPDATE 7-17-22

Chiropractic Forms

Chiropractic Patient Forms

  1. *Chiropractic New Patient Form (Print, fill out, and bring in with you)
  2. *Chiropractic Informed Consent Form (Print, read, and bring in with you “unsigned”)
  3. *COMMUNICATION POLICIES UPDATE 7-17-22 (Print, fill out, and bring in with you)
  4. *YOU DO NOT NEED TO PRINT THIS OUT. NOTICE OF PRIVACY PRACTICES – HIPAA. I am required by law that I offer this to you. These are your privacy rights as a patient. 

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

Distance Client Forms:

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 Forms:

  1. *Policies and Fees  Please read every policy thoroughly. Do not just initial this document w/o reading it thoroughly. I am a one-man show and I need to enforce every policy, if violated, to keep the practice running smoothly.  
  2. *Health Consultant Status 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 ALL supplements and medications.

 

Office Handouts:

Cancer

Electrolytes (Sodium, Potassium, Calcium, Chloride…)