Forms and Handouts

Welcome to the Advanced Healing Center of Orange 

 

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

 

Consultation Forms (For In-Office and Telemedicine Patients)

1. Please print and complete the five (5) forms below.

2. All your forms must be filled out and brought to your new patient appointment. If possible, please scan and email the forms/labs/tests beforehand to—info @ advanced healing .com.

3. THIS IS VERY IMPORTANT: If you arrive without your completed forms, 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. Don’t just initial this document without reading it thoroughly.
  2. Credit Card Authorization Form
  3. Health Consultant Status Form
  4. Metabolic Assessment Form
  5. Three-Day Food Diary (Print out just one page if your appointment is within the next 48 hours). Include ALL supplements and medications.
  6. (Only if you are 65 or older)Social Frailty Index – This tool can predict longevity and identify at-risk individuals who could benefit from measures that address the social issues affecting their health.
  7. *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.

 

Chiropractic Forms

  1. Policies and Fees: Please read every policy thoroughly. Don’t just initial this document without reading it thoroughly.
  2. Chiropractic New Patient Form
  3. Chiropractic Informed Consent Form (Print, read, and bring in with you (“unsigned”)
  4. Realistic Expectations and How To Communicate With Dr. Ettinger  (Print, fill out, and bring in with you)
  5. *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.

 

Office Handouts:

Cancer

Electrolytes (Sodium, Potassium, Calcium, Chloride…)