New Patient Forms

The purpose of this Potential New Patient Form is to ensure that Dr. Molly can help you with your health concerns, and that your health goals align with her functional medicine practice. 

Instructions:

1. This form takes approx. 10 minutes to complete

2. You will have 48 hours to fill in and submit this form once your initial appt. has been booked

3. Press the “Click Here” box below to access your form online

4. Fill in the form online.  Make sure to press “Save” and “Submit”

5. Dr. Molly will review your form 

6. We will get back to you within 48 hours to either confirm your initial appt. or provide a referral (where feasible)

Please note:  If your form is not received within this time frame we will have to release your appointment as we have a waiting list of patients who would like to get in to see Dr. Molly.

Your intake form outlines your important health history and current health concerns.  Dr. Molly needs this form so she can identify the causes and patterns of your symptoms, begin to identify the potential root cause(s) and provide you with the best possible care.  It’s in your best interest to provide as much detail as possible.

Instructions:

1. Fill in this form after your Potential Patient Form has been submitted and your initial appt. has been confirmed

2. This form takes approx. 30-45 minutes to complete

3. Press the “Click Here” box below to access your form online

4. Fill in the form online.  Make sure to press “Save” and “Submit”

5. Please make sure your form is submitted 2 business days (at the latest) before your initial appt. 

Please note:  If you are unable to provide your intake forms 2 business days prior to your initial appt. you will need to reschedule your appt.  Dr. Molly will not be able to provide you with medical care without this information.  We will allow for one appointment reschedule due to incomplete forms.