Dr.
Sam Schikowitz
Naturopathic Doctor
Acupuncturist
Western and Chinese Herbalist
Natural, Integrative, and Holistic Health Solutions
“Real healing takes place when we can envision a new kind of future for ourselves.”
Download Intake Forms
Prior to your first visit, there are 3 intake forms for you to fill out for yourself or your child. You can download these from this site, (at the bottom of the paragraph,) request that Dr. Schikowitz send them to your home, or pick them up at the clinic. The forms include a number of questions addressing diet, lifestyle, past medical history, and family medical history. They also include consent and release forms. Please take time to fill these out completely. All the answers are important in understanding you or your child as a whole person and will greatly aid in the evaluation of your health conditions. Please allow yourself some time to fill out the paperwork before your visit. Furthermore, bring in any medications, vitamins and supplements being taken. If you have a copy of recent labs, bring those as well.
Download intake forms:
Adult (PDF Format)
Child or Adolescent (PDF Format)
Other Forms:
Diet Diary Instructions (PDF Format)
Diet Diary (PDF Format)
Records Release (PDF Format)
