Patient Forms

For all follow-up appointments, please complete our Follow-up Patient Questionnaire 

If you are new to Healing Family Functional Medicine, please complete our Individual (Adult & Child) New Patient Questionnaire

If you are scheduling more than one child as a new patient, please complete our Multi-Child New Patient Questionnaire

For all current and former patients of the Cleveland Clinic, please complete the Cleveland Clinic Dr. Connect Release Form, which will allow us to view your medical records electronically. 


These questionnaires are designed to effectively evaluate patients, create personalized care plans, and track superior health outcomes over time. You can save your progress at any time. Before getting started, we recommend having digital copies of your insurance card and pertinent medical records, bottles/labels of medications/supplements, and contact information for your primary care physician or referring physician. Having these items ready will allow for a quick and easy experience. Please read each question thoroughly and answer to the best of your ability.

If you have any questions please contact Colleen@HealingFamilyFunctionalMedicine.com