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 (5) forms under the heading, “Natural Health Forms.”
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:
- Policies and Fees Please read every policy thoroughly. Do not just initial this document w/o reading it thoroughly.
- 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.
- Credit Card Authorization Form
- (Only if you are 65 or older) Social Frailty Index – This is a tool that can be used to predict longevity and identify at-risk individuals who could benefit from measures that address the social issues affecting their health.
- Please DO NOT print this form unless you would like a copy for your records. NOTICE OF PRIVACY PRACTICES – HIPAA. I am required by law to provide this to you. Read through it if you like. These are your privacy rights as a patient.
Chiropractic Forms
Chiropractic Patient Forms
- Policies and Fees Please read every policy thoroughly. Do not just initial this document w/o reading it thoroughly.
- Chiropractic New Patient Form
- Chiropractic Informed Consent Form (Print, read, and bring in with you “unsigned”)
- Realistic Expectations and How To Communicate With Dr. Ettinger (Print, fill out, and bring in with you)
- *You DO NOT need to print this form unless you would like a copy for your records. NOTICE OF PRIVACY PRACTICES – HIPAA. I am required by law to provide this to you. These are your privacy rights as a patient.
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:
- *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.
- Credit Card Authorization Form
- *You DO NOT need to print this form unless you would like a copy for your records. NOTICE OF PRIVACY PRACTICES – HIPAA. I am required by law to provide this to you. These are your privacy rights as a patient.
Additional Forms: (ONLY if requested by Dr. Ettinger)
- Credit Card Authorization Form
- For Informational Purposes Only – Functional Medicine Diagnostic Testing
- This is for Office Use Only. DO NOT PRINT THIS FORM. COMMUNICATION POLICIES UPDATE 7-17-22
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
- HPA-HPT Axis Chart
- Chronic Stress Response Chart
- Steroidal Hormone Pathway Chart
- Rudolf Steiner – Substances as Vessels for Forces
Cancer
- The Contribution of Chemotherapy on 5-year Survival Rate
- High Doses of Antioxidants Including Vitamin C Do Not Decrease the Efficacy of Chemotherapy
- 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
- Solar Ultraviolet Radiation and Breast Cancer Risk: A Systematic Review and Meta-Analysis
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