Healing Family Functional Medicine – North Carolina

(704) 237-0603 Request An Appointment
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Forms

New Patients:

Please complete our Individual (Adult and Child) New Patient Questionnaire.

Follow-up Patients:

Please complete a brief Follow-up Patient Questionnaire prior to each follow-up appointment.

Clinical Questionnaires (if requested by Dr. Patel only):

  • Horowitz Lyme-MSIDS Questionnaire 
  • Medical Symptom/Toxicity Questionnaire (MSQ) 
  • Mold Toxicity Questionnaire 
  • Promis – Global Health Questionnaire (Ages 13+)
  • Release of Medical Records (From another facility to Healing Family Functional Medicine NC) 

 
 

REQUEST AN APPOINTMENT

  • Serving the areas of North Carolina, South Carolina & Virginia
  • (704) 237-0603

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Contact Us

Serving the areas of North Carolina, South Carolina & Virginia

Contact (704) 237-0603

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