Francis Holistic Medical Center

N. Thomas LaCava, MD, Medical Director                                             Treating the Cause of Complex Chronic Illness

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Contact Us

ADULT PATIENTS (16 years of age and older)

If you are interested in setting up an initial comprehensive visit with Dr. LaCava, please contact our office at (508) 854-1380.

We provide extra appointment time for first visits, so it is very important to let us know if you are not going to come to your appointment. Should you need to reschedule or cancel your appointment for any reason, please do so at least three business days prior to your appointment.

These appointments are scheduled for an hour in duration, but please plan to be here for approximately up to two hours.  The initial visit requires questionnaires, checklists, and summaries that need to be completed by the patient (or parental guardian, if the patient is a minor).  These forms can be sent to you by mail, or you can download them here on our website below. If you are not sure which forms to use, or have questions about the forms, please call us at 508-854-1380 on Monday, Wednesday or Thursday.

Please do not put your social security number on any of our forms. If one of our forms still asks for that, leave the field blank. Your privacy is very important to us. We do not collect social security numbers, in order to further protect your privacy.

Please print each item in blue or black ink, and complete and return them to our office as soon as possible. Do not use email to return these forms. Email is not secure, and the quality is very poor.  

Please do not bend the left edge of these forms, since they will be passed through a copy machine. The originals will be returned to you, so you can start your own health file at home.

The forms that are appropriate for you need to be completed in full and returned to our office for receipt BEFORE your appointment.  We highly recommend that you have these documents returned to the office AT LEAST ONE WEEK prior to your visit.  Please note, if you send your information in advance, you will have a much better experience, since our physician will become familiar with your case in advance.  For more information, or if you have questions, please contact our office and we will be happy to assist you.
 
FORMS

To download the forms required for your initial visit, you will be clicking on selected links below. These forms are stored as Adobe pdf files (portable document form files). You will need the free Adobe Reader program in order to view them. Most computers have this already installed.  If you do not have this program, you may obtain it by clicking on this link to the Adobe website:  https://get.adobe.com/reader/



For all patients, these two forms are required:

Patient Registration
 
Authorization


All patients 16 years and older should also fill out these two forms:

Food Frequency Questionnaire (Adult)

Chronological Summary


There is only ONE (1) additional form to complete -

PLEASE CHOOSE ONE OR THE OTHER, BUT NOT BOTH of the following:


(please do Choice A  or  Choice B, but not both)

-----------------

Choice A:

IF your symptoms vary from day to day or week to week or month to month,
then you should fill out this form:

Adult Allergy Database & Health History
(for patients 16 years old and older)

If you have chosen that form, you are done.

-----------------

Choice B:

Otherwise, only if you did NOT choose the above form (choice A), then please fill out one of the following two forms        (the "Initial Health Survey" form that is appropriate for your gender):

Initial Health Survey for Men - 2016

Initial Health Survey for Women


Important Note:

P
lease do NOT fill out BOTH the Allergy form AND the Initial Health Survey form. This will cause needless work for you.
Choose one or the other, but not both!

If you cannot decide which form to fill out, please call the office and someone will help you decide.



Friendly reminder:  Do not use email to return these forms, it is not secure.  


We are a fragrance free office. Click HERE for more details about that, and to read our cancellation and privacy policies.

Otherwise, use our menu system at the top to navigate our website.



We provide integrative, functional medicine in Central Massachusetts in the Worcester area. Many of our patients come from Boston and the Metrowest Boston area as well as all areas of Massachusetts and the other New England states.

(C) Copyright 2013 and 2016 Francis Holistic Medical Center, Last Modified: April 17, 2017 at 3:47 pm EST