Patient Information
Before your visit:
Please print and complete the following forms that are applicable to you and bring them on your first visit. The forms with an asterisk (*) are required. All forms are in .pdf format. You will need Adobe Acrobat Reader to view and print these forms. Click here or below to download.
- Confidential Patient Information*
- Confidential Pediatric Information (print only for patients who are children)
- Diet and Lifestyle Information (optional)
- History of Injury*
- History of Pain*
- Multiple Symptoms Questionaire*
- Diet Journal (for weight loss)
- Metabolic Symptoms Questionnaire (for weight loss)
- Brain Symptoms Questionaire (optional)
- Neurotransmitter Questionaire (print only if issues relate to mental/emotional issues)
- Medications (print only if you take any medications/supplements)
- Office Policy*
- HIPAA Privacy form*
Click below to read about our office fees:
Determining what YOU want:
We will begin by identifying your goals and/or problems you want to eliminate. This requires a thorough interview of how your problems began, a survey of body function and dysfunction, what you have tried and are currently trying to reach your goals.
Collecting Data:
We then begin to measure markers of health and disease (posture, neurological function, and typically blood or other chemistry markers; i.e., inflammation, sugar regulation, hormone function). We may decide to take X-Ray pictures to measure to the millimeter any imbalance and assess the overall health of your spine and nervous system.
Creating an action plan:
We will schedule a time to review your exam & test results, to identify what needs to be balanced, and to set up a regimen to meet those needs. This may include supplements, diet, exercise, or in office therapy based on the findings from our collection of information and your current health.
Listening to feedback:
We will schedule a re-evaluation after 1-3 months to collect new data: labs and physical exam measures and personal feedback about how the program is working, how you are feeling and functioning. We will then make changes as necessary or find that your have met your goals. You can then decide if you have new goals you would like to work toward or if you are ready to be released from active care.
Please print and complete the following form and bring to your re-examination visit:
Staying well:
I recommend routine care and labs for maintaining health (just like regular dental and eye exams). Patients who live out of town may have labs drawn in any Lab Corp location, or I can refer them to a practitioner in their area that provides annual or semiannual labs, physicals, or other care to stay healthy and increase their GAP.
Obtaining Labs:
Lab tests can be ordered without seeing Dr. Stone personally. If you choose to run a lab without an office visit, you must sign a waiver of liability indicating that you are not a patient of True Health Family Wellness Center and that the lab results and written report and recommendations are for informational purposes only. A single lab test is not to be substituted for personal medical evaluation and care.
Each lab will come with a written report explaining the results, with dietary and supplement recommendations based on the results. You will receive the results and report via your choice of regular mail, email, or fax. The supplements recommended (if appropriate) are produced by a variety of companies nationally and internationally and can be ordered directly through our office, or you can call the company for a local physician referral that carries that brand.
To purchase a lab test, call our office directly, or complete and fax the order form below.
Always remember…you are the consumer, and I, or any health professional, can be hired or fired. I personally appreciate your feedback if I am not meeting your needs and want you to know that your goals are my goals for you. Let me know how I can help!
Resource Links
GENERAL INFORMATION
Labcorp: Locate a lab draw station near you.
www.labcorp.com
PURE Encapsulations - Drug Depletions and Interactions: Look up your medications and see what nutrients that are depleted by taking the medications, and if there are any supplements that you should not be taking with that medication.
www.purecaps.com
PUBMED: National Library of Medicine search engine for published research. Easy key word search…email with questions or interpretation, it is a medical facility.
www.ncbi.nlm.nih.gov
NUTRITIONAL COMPANIES WE USE AND RECOMMEND:
USANA: The top rated multivitamin/mineral supplement in the US and Canada, which we personally use. You can order directly by contacting our office.
www.usana.com
Greens First: A quality green drink that we personally use and recommend. You can order directly from this website.
www.firstshake.com
Metagenics: Top of the line physician supplements that we carry.
www.metagenics.com
Biotics: Top of the line physician supplements that we carry.
www.bioticsresearch.com
Thorne: Top of the line physician supplements that we carry.
www.thorne.com
Standard Process: Top of the line physician supplements that we carry.
www.standardprocess.com
NutriWest Blue Ridge: Top of the line physician supplements that we carry.
www.nutriwestblueridge.com
FUNCTIONAL LAB TESTING
Genova Diagnostics
www.gdx.net
Diagnostechs
www.diagnostechs.com
Doctors Data
www.doctorsdata.com
Neuro Science
www.neurorelief.com
Meta Matrix
www.metametrix.com
CHILDREN
International Chiropractic Pediatric Association Research Site: Research links from the National Library of Medicine regarding effectiveness of antibiotics for ear infections, vaccine dangers, and the benefits of Natural Health Care for kids.
www.icpa4kids.org
The Bradley Method ®: Natural Childbirth is a powerful, exciting, and extraordinarily satisfying experience. The Bradley Method® encourages mothers to trust their bodies and to work with the natural progression of labor using deep relaxation and natural breathing techniques.
http://bradley4birth.com
La Leche League International: To help mothers worldwide to breastfeed through mother-to-mother support, encouragement, information, and education and to promote a better understanding of breastfeeding as an important element in the healthy development of the baby and mother.
www.lalecheleague.org
NEURO-EMOTIONAL RESOURCES
EFT (Emotional Freedom Technique): Learn to explore and heal your own emotional issues and belief systems
www.emofree.com
NET: Patient information from the creators and professors of Neuro-Emotional Technique
www.netmindbody.com
QUANTUM PHYSICS
What the Bleep?!: Site based upon the movie of the same name.
www.whatthebleep.com
Bruce Lipton: Cell biologist that lectures nationally on genetics, thoughts and reality.
www.brucelipton.com
NATURAL HEALTH
Mercola: The largest natural health site in the world. Tons of information you won’t read in popular media.
www.mercola.com
Dr. Gangemi: A chiropractor and applied kinesiologist practicing in Durham, NC. Lots of great content about achieving higher levels of health.
www.drgangemi.com
Your Medical Detective: Natural health site developed by an innovative chiropractor.
www.yourmedicaldetective.com
Weston A. Price Foundations: Nutrition pioneer Dr. Weston Price, whose studies of primitive cultures established the parameters of human health and determined the optimum characteristics of human diets. Dr. Price's research demonstrated that humans achieve perfect physical form and perfect health generation after generation only when they consume nutrient-dense whole foods and the vital fat-soluble activators found exclusively in animal fats.
www.westonaprice.org
NEUROLOGICAL RESOURCES
IAHP: The Institute for Achievement of Human Potential. Books, videos, and seminars about helping your baby develop neurologically, as well as help for brain injured children.
www.iahp.org
DANA: The Dana Foundation is a private philanthropic organization with particular interests in brain science, immunology, and arts education.
www.dana.org
NEUROSCIENCE FOR KIDS: Neuroscience for Kids has been created for all students and teachers who would like to learn about the nervous system.
http://staff.washington.edu
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