Welcome to the Advanced Healing Center of Orange 

Natural Health Consultation Forms

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 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.

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, Marcus Ettinger, DC”

Natural Health Forms:

1. *Policies and Fees 01-Jan-19
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 supplements and medications.
5. *BioHealth Diagnostics Survey (men and women, fill out all sections).
6. PLEASE READ – My Policy on Email and Phone Calls 
7. PLEASE READ  – NOTICE OF PRIVACY PRACTICES – HIPAA

Chiropractic Forms

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 READ – My Policy on Email and Phone Calls

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 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 READ – My Policy on Email and Phone Calls 

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
• 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

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