New Patient Intake Form (Required):

This form will give us your health information past and present.

Stress Assessment (Optional):

This form will let us know how your body is dealing with stress and what type of stressor you are.  There are 5 different types of stressors.  By finding out how you react to stress we can determine proper nutritional support to help you deal with stress in a better way.

Health Appraisal Questionnaire (HAQ) (Optional):

This questionnaire asks a variety of questions that are specific to each organ system in your body.  The results will show if an organ system is healthy, inflamed or in a weakened/chronic state.  Once you fill out the sign-up sheet below, we will sign you up for your HAQ.  You will receive an email with your user name, password and link to the website.  You can change your password at any time.  Dr. Bahr will go over your results upon your next visit and will inform you of any nutritional support she finds necessary to help balance any effected organ system(s).

HAQ Sign Up Form

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First Name: *

Last Name: *

E-Mail Address: *

Sex: *

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Age: *

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