COMPLETE ONLINE

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Complete the New Patient Forms Online

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Want to Upload Additional Documents?

Make sure you have your name on each document so we put them in your medical folder

Check list

Remember your Appointment:

Write down appointment time & put it in your digital calendar and download your patient kit here.

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Complete & Submit Your intake forms

  • Comprehensive Health History

  • Notice of Privacy Practices

  • Informed Consent (for WA, MT, and CA)

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Submit Your Labs

  • All recent blood work results

  • All imaging results (mammogram, ultrasound, X-ray, MRI, CT, Bone, PET scan)

  • Pathology reports

  • Colonoscopy results

  • PAP results

  • Functional lab results (genetic tests, microbiome, neurotransmitter, nutritional, hormone, methylation status, biomarkers, ect)

  • Home water tests

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PREFER PHYSICAL COPIES?

A comprehensive health history form from Dr. Michele Burklund, including personal information, medical history, allergies, health concerns, and family health history sections.

COMPREHENSIVE HEALTH INTAKE

A white medical consent form titled 'INFORMED CONSENT' from Dr. Michele Burklund, detailing medical and treatment information for patients, including notices to cancer patients and women, and patient rights and responsibilities.

NOTICE OF PRIVACY PRACTICES

Privacy practices notice document from Dr. Michele Burklund with HIPAA information and contact details.

INFORMED CONSENT (WA, MT, CA)

Thank you for answering all the questions, I know it was a lot.


Complete answers to all of the questions are to your benefit for the most effective naturopathic assessment, diagnosis and treatment.

This is a confidential record of your medical history and will be kept in this office.

Information contained here will not be released to any person except when you have authorized us to do so.

Informational Guides

DR. MICHELE BURKLUND PATIENT DOWNLOAD
DR. MICHELE BURKLUND PATIENT DOWNLOAD
DR. MICHELE BURKLUND PATIENT DOWNLOAD KIT