Forms

ALL Patients and visitors: Please be aware that we try and maintain a healthy environment for all. Please do NOT wear any fragrances or perfumes into our office. This includes clothing that may have been washed in scented detergents as well as personal care products such as soaps, shampoos, hair sprays, after-shave products, lotions, etc. These products tend to be potent endocrine disruptors as well as general toxins. You may be asked to re-schedule your appointment if you arrive “scented”. Thank you for your understanding and support of health!

NEW PATIENT FORMS:  Please download these new patient forms, fill them in completely, and bring them to your first appointment.

PLEASE note that Dr. Brown needs to have your completed forms at least 15 minutes prior to your appointment time or you may be asked to reschedule.

New Patient Forms

HIPAA Notice of Privacy Practices

 

ADDITIONAL FORMS for existing patients:  Please complete these forms only as prescribed by Dr. Brown.

NT AF for Adults

MAF for Adults

CNNQ Form for Children

Release of Records

Brain Function Assessment Form

Brain Health and Nutrition Assessment Form

WT3 Worksheet