6611 Gunn Highway, Tampa, FL 33625

Initial Medical Questionnaires

for Affinity Wellness




1.    For all visits, except Medical Marijuana, CLICK HERE.


2.    For the initial Medical Marijuana visit - Please call the office at 813-964-5901 and ask to have the Brief Medical

       Questionnaire emailed to you. ***



***If your appointment is for Medical Marijuana and you would like a more extensive evaluation for your health issues, please click on the link in #1. This includes issues such as low thyroid, hormone replacement, high cholesterol, fibromyalgia, irritable bowel, Crohn's Disease, autoimmune issues and others where you desire to find the root cause of your issue(s), reduce or eliminate medication(s) or completely restore yourself to optimum function or substantial improvement.



Your initial appointment will be around 60 minutes with a physician. The physician will review your LivingMatrix Questionnaire with you. In order for you to benefit from this consultation it is important you fill out the forms completely. Dates are very important. If you do not know a specific date, just estimate.



We do not 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.