Please 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!
Please print each item on each form in blue or black ink, and complete and return to our office as soon as possible.
Do not use email to return these forms, it is not secure, and the quality is very poor.
Click HERE to go back to the main forms page, which has the four forms required of all patients.
We are a fragrance free office. Click HERE for more details about that, and to read our cancellation and privacy policies.
Otherwise, use the menu above 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: March 23, 2017 at 6:20 pm EST