813.964.5901

6611 Gunn Highway, Tampa, FL 33625

  Initial Visit Forms:

 

 

    All Patients Click Here For Initial Office General Forms

 

Then click on the appropriate form(s) below

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Female Functional Medical History Form

 

OR

 

Male Functional Medical History Form

 

OR

 

Medical Cannabis Medical History Form

 

** If you desire a more extensive Functional Medicine evaluation and/or feel you have an underlying issue that has not been addressed or identified, please utilize the appropriate Functional Medical History Form above. The initial fee will also be our regular initial office visit fee.***

 

AND

 

Lyme Disease / MSIDS Form

 

(If you think you may have Lyme or an associated disease, have ever had a tick bite, unexplained rash, had previous testing and told you didn't have Lyme, or any of the symptoms listed here)

 

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We do not file or accept insurances, but they may be utilized for laboratory work.

Bring in your insurance card for your initial visit

 

Insurance FSA / HSA cards can be used for the office visit.

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