Francis Holistic Medical Center

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.

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. Each link opens an Adobe pdf file.  You will need the free program Adobe Acrobat Reader or Adobe Acrobat 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 referred patients, these four forms are required:

Patient Registration

Choosing the Forms to Complete

You do not need to complete every form listed. Only complete the forms that apply to you. We will explain this.

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

Food Frequency Questionnaire (Adult)

Chronological Summary


IF your symptoms vary from day to day or month to month, and you believe the symptoms may be triggered by environmental exposures (including chemicals, allergies, tick-borne disease) then you should fill out one of these two forms:

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

Pediatric Allergy Database & Health History
(for patients 15 years old and younger)


If these forms are NOT appropriate for you, then for an adult (16 years and older) please fill out one of the following two forms:

Initial Health Survey for Men

Initial Health Survey for Women

Please print each item indicated, and complete and return them 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.  

Should you need to reschedule or cancel your appointment for any reason, you must do so at least three business days prior to your appointment. 

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Pediatric patients referred by another doctor

The responsible party for PEDIATRIC patients (persons 15 years old or younter) referred from another doctor who are seeing Dr. LaCava for their initial visit should complete the following two forms:

Food Frequency Questionnaire (Pediatric)
(for patients 15 years old and younger)

Chronological Summary for Children
(for patients 18 years old and younger)

Please print each item indicated, and complete and return them 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.  

Should you need to reschedule or cancel your appointment for any reason, you must do so at least three business days prior to your appointment.


If your child is (or will be) a primary care pediatric patient of Dr. LaCava, please go to our other menu choice, Primary Care First Visit.