COMPLETE ONLINE

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Complete the New Patient Forms Online

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Want to Upload Additional Documents?

Upload Medical records here

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

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BILLLING PHILOSOPHY

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

Download & Fill Out
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

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

INFORMED CONSENT (WA, MT, CA)

Download & Sign
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.

BILLING PHILOSOPHY

Download & Sign

Thank you for taking the time to share so openly.
Your thoughtful responses help us gain a deeper understanding of your whole health story — supporting a more personalized, effective, and truly integrative naturopathic approach.

All information shared here is held in complete confidence and stored securely within this practice. Your details will never be released to anyone without your expressed permission.

About Our Practice & Offerings

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