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SIBO Guru New Patient Forms

PRIOR TO YOUR APPOINTMENT:

INTAKE PAPERWORK INSTRUCTIONS

For your convenience, the intake paperwork is offered in fillable PDF. Though the forms are fillable online, you will not be submitting these directly to me through this site. Please fill in the paperwork, save it to your desktop (please make sure that the forms are saved WITH your data prior to closing the fillable PDF form) and then email or fax them to my office.

Introductory “Intro” Consults – please fill out the Pre-Appointment Questionnaire and email it to scheduling@SIBOGuru.com

90 Minute Intake Sessions, you will find four sets of forms linked below. Please send me these completed forms, along with a copy of any and all labs that you have access to and return these via fax: 425.274.1554, or email scheduling@SIBOGuru.com at least 48 hours prior to your appointment. I spend, on average, 1 hour reviewing all intake paperwork so I am prepped and ready for your intake session.

If you have a very long history, with a large packet of labs, please consider mailing your intake paperwork to me Angela Pifer c/o Synergy Wellness Center 515 Kirkland Way, Kirkland, WA 98033

Our first intake appointment must be via video and not a simple phone call. After our initial intake video session, communication will continue via phone and email support.

Pre-Appointment Questionnaire

New Patient Intake Form

Digestive Wellness Assessment

SIBO Questionnaire

Health History Timeline * is not a fillable PDF. Please print, fill out and fax back

Please make sure that the forms are saved WITH your data prior to closing the fillable PDF form