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This form collects essential information for a comprehensive functional medicine health assessment, covering medical history, lifestyle, and health goals.

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How to fill out functional medicine initial intake

01

Gather personal information such as name, age, gender, and contact details.

02

Document your medical history including previous diagnoses, treatments, and surgeries.

03

List your current medications, supplements, and any allergies.

04

Describe your lifestyle habits including diet, exercise, sleep patterns, and stress levels.

05

Include family medical history to identify potential genetic health issues.

06

Detail your current symptoms and health concerns in as much detail as possible.

07

Provide information on any recent medical tests or lab results.

08

Complete any additional questionnaires related to specific health issues or areas of concern.

Who needs functional medicine initial intake?

01

Individuals experiencing chronic health issues that haven't responded to traditional treatment.

02

People looking for a holistic approach to their health and wellness.

03

Patients seeking preventive care and personalized health plans.

04

Anyone interested in understanding the root causes of their health problems.

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What is functional medicine initial intake?

Functional medicine initial intake refers to the comprehensive assessment and collection of a patient's medical, lifestyle, and psychological history to identify the root causes of health issues.

Who is required to file functional medicine initial intake?

Patients seeking functional medicine treatment are typically required to file an initial intake form.

How to fill out functional medicine initial intake?

To fill out functional medicine initial intake, patients should provide detailed information about their medical history, current medications, lifestyle choices, and any symptoms they are experiencing.

What is the purpose of functional medicine initial intake?

The purpose of functional medicine initial intake is to gather holistic insights into a patient's health to create an individualized treatment plan.

What information must be reported on functional medicine initial intake?

Information such as personal health history, family health history, current medications, supplements, diet, exercise habits, and symptoms must be reported.

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