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. Please see form #1 for more details.
Natural Health Forms:
- *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.
- *Health Consultant Status Form
- *Metabolic Assessment Form
- *Three-Day Food Diary (Print out just one page if your appointment is within the next 48 hours). Include ALL supplements and medications.
- *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.
Chiropractic Forms
Chiropractic Patient Forms
- *Chiropractic New Patient Form (Print, fill out, and bring in with you)
- *Chiropractic Informed Consent Form (Print, read, and bring in with you “unsigned”)
- *Email, Phone, and Zoom Policies and Fee Schedule 05-24-2020 (Print, fill out, and bring in with you)
- *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)
- Medical Records Release Form
- Neuro-Transmitter Assessment Form
- Credit Card Authorization Form
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 Program Application, Instructions, Costs:
- Distance Client Program revised 01-January-19 (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 other applicable forms and tests. Thank you.
Office Handouts:
- Dr. Ettinger’s Paleo-Work-Book-1-31-12-update-2-2-16 (routinely updated)
- Optimum Consistency and Quality of Poo – Bristol Stool Chart
- The Evolution-Informed Optimal Dietary Potassium Intake of Human Beings Greatly Exceeds Current and Recommended Intakes
- 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
- Rudolf Steiner – Substances as Vessels for Forces
- High Doses of Antioxidants Including Vitamin C Do Not Decrease the Efficacy of Chemotherapy
- The contribution of chemotherapy on 5-year survival rate
Cancer
- Predictors of disease progression in ductal carcinoma in situ of the breast and vascular patterns.
- Management of Ductal Carcinoma In situ
- Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma
- Doctors suggest new names for low-grade prostate cancer
Electrolytes (Sodium, Potassium, Calcium, Chloride…)
- Low-normal serum potassium is associated with an increased risk of cardiovascular and all-cause death in community-based elderly
- What is the optimal serum potassium level in cardiovascular patients?
- Baking soda and autoimmune disease
- The Evolution-Informed Optimal Dietary Potassium Intake of Human Beings Greatly Exceeds Current and Recommended Intakes