Patient Forms

Please print, fill and bring the forms with you on your initial consultation. You can also fill the forms online and email to This email address is being protected from spambots. You need JavaScript enabled to view it.

Before signing the consent form you must consider that you have got all the information you want or need and that you understand the details and implications of your treatment:

First Adult Treatment Consent Form

Please note that personal data will not be disclosed to third parties and will only be used for internal functions relevant to my practice:

Medical Questionnaire

Patient Health Status and Symptom Scoring Chart (coming soon)

If you are coming for pain disorders / chronic fatigue or ME / fibromyalgia consultation, please print and fill the below questionnaire when coming:

Pain and Fatigue Screening

For Lyme disease patients only:

Lyme Disease Questionnaire