Resource Library

Please print and complete each of the following forms before you come to your first office appointment. Having these forms completed is essential in order to optimize your time spent with your doctor.   Please also bring copies of the most recent blood work, scans or tests completed by your MD or other health care providers. You can also complete the Release of Records form (for each pertinent health care provider) and bring to your initial visit. This form will then be faxed on your behalf to receive copies of lab results required or discussed. Required:

  • Release of Records

Release of Records Form

  • First Office Visit Intake Form (click on the appropriate form below)

Dr. Fleury Adult Intake form
Dr. Fleury Pediatric Intake Form
Dr. Ahenakew Adult Intake form
Dr. Ahenakew Pediatric Intake Form
Dr. Marcoux Adult Intake Form
Dr. Marcoux Pediatric Intake Form
Dr. Michelle Marcoux, ND Group Acupuncture Intake Form
Dr. Whelan Adult Intake form
Dr. Whelan Pediatric Intake Form
Dr. Pihowich Adult Intake form
Dr. Pihowich Pediatric Intake Form
Drs. Pihowich and Marcoux, Smoking Cessation Program
Bree Rutten Patient Intake and Consent Form

Other Forms

Return Visit Follow Up Form

Environmental Toxic Exposure