One of the hallmarks of naturopathic medicine is that everyone is a unique individual. When it comes to health
care there is no such thing as "one size fits all" (or even "one size fits most"). In order to provide the most
appropriate health care for you, we need to get to know you and how your body functions.
There are two categories of forms below: Health information and informed consent. A physician with
All Ways Health will tell you which of the health information forms you need to complete before your first appointment:
It is highly unlikely that you will have to complete all of them.
The informed consent forms are copies of the forms you will need to sign at your first appointment. They are posted
here for your reference and we encourage you to read them in advance of your first appointment.
All forms are in Adobe Acrobat (PDF) format and you will need to have either Adobe Acrobat or the FREE Adobe Acrobat Reader program
installed on your computer to view them. If you do not have either of these programs on your computer, you can download a free
copy of the Adobe Acrobat Reader by clicking on the icon to the right.
Health Information Forms
These forms need to be downloaded to your computer. Once they have been downloaded, use Adobe Acrobat to view
and fill-in the forms. These forms may take you a while to complete and you may not be able to complete them in one sitting.
You can always save your partially completed form and return to work on it again at a later time.
Once you have completely finished the form, click on the PRINT button at the top of the form.
A copy of the form will be printed on your printer. Please mail the printed form to All Ways Health at
PO Box 1970, Flagstaff, AZ 86002 OR hand deliver it to our offices at 1301 W. University Ave., Suite 2, Flagstaff.
IMPORTANT: Do NOT complete these forms using a public computer. Your personal information
and medical history should be kept confidential. If you do not have your own computer, simply print off a copy of these forms
and complete them by hand.
Complete only the forms a physician at All Ways Health tells you to complete.
NOTE: Whenever possible we have tried to use plain English (as opposed to medical terminology) in these forms.
We have also included a glossary at the end of many of these forms defining and clarifying those terms which
might not be well known. As always, if you have any questions about these forms or how to complete them, please
don't hesitate to call our office - 928-779-1100. We'll be happy to assist you.
#11. Basic Patient Information (Demographics) for Adult Patients
#12. Basic Patient Information (Demographics) for Minor Patients
#20. Brief Health History and Current Status
#21. Comprehensive Health History for Adults
#22. Comprehensive Health History for Minors
#32. Current Health Status for Children
#34. Current Health Status for Adult Females
#38. Current Health Status for Adult Males
#40. Parent of Adolescent Questionnaire
#41. Early Adolescent Questionnaire
#42. Middle/Late Adolescent Questionnaire
#51. Simple Food and Beverage Journal (You will also need the Bristol Stool Chart)
#55. Blood Sugar Journal
#58. AUA Symptom Scoring Sheet
#61. Learning Challenges Questionnaire
#62. Scotopic Sensitivity Syndrome (Irlen) Questionnaire
#63. Giftedness and Asperger's Syndrome Questionnaire
#81. Instructions for Basic Medication Review
#82. Instructions for Personal Medication and Supplementation Review
#83. Instructions for Comprehensive Medication, Supplementation, and Diet Review
#84. Prescription Medications Form Set
#85. Non-Prescription Medications Form Set
#86. Supplementation Form Set
#87. Diet Journal Form Set
#91. Medical Records Request (You want a doctor to send your records to All Ways Health.)
#92. Medical Records Release (You want All Ways Health to send your records to another doctor.)
#93. Parent's Request for Minor Patient's Medical Records
Informed Consent Forms
These forms are provided here for your information. Please take a few moments to read and become familiar with
the forms that apply to you. You will be asked to sign the appropriate forms when you come to All Ways Health
for your appointment.
Practice Policies and Informed Consent for Medical Services - All patients.
Acupuncture Informed Consent - Only for patients receiving acupuncture.
Hypnotherapy Informed Consent - Only for patients receiving hypnotherapy.
Minor Surgery Informed Consent - Only for patients receiving minor surgery.