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Guide to Eating for Optimal Fertility and Hormonal Balance

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New Patient Forms

Diet History
Functional Medicine – Men
Functional Medicine – Women
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When downloading this form, please save it to your computer and note where on your computer you saved it. Once you have completed the form and signed it by typing in your name, please click on File, Save. Then click on the ‘Email your form’ link below and attach the saved form to the email. You can also print out the form and bring it with you to your first appointment if you’d prefer to do that. Please call if you have any questions.

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