New Patient Forms

“Listen to the patient. He will tell you what’s wrong with him.”
    ~Sir William Osler

According to research 35%-56% more information is gathered by using forms. This leads to improved communication and a quicker diagnosis.

Once you complete the new patient packet and drop off at the clinic, fax or send electronically, you will be contacted within five business days and scheduled for an appointment. Email is the least secure method, but will be accepted if you chose this method. Please see the Contact Us tab for email and fax numbers.

Well Life ABQ apologizes for the paperwork, but this method saves us time during your first appointment.

New Adult Patient Paperwork
New Pediatric Patient Paperwork

Seperate 3 Day Diet Diary
MSQ - Medical Symptom/Toxicity Questionnaire

If you are coming in for a pediatric well child check, please see the Member's tab and print off and fill out the Ages and Stages Questionaire for the appropriate age.

If medical records from another provider is needed, we will have you complete a medical records release form after your initial consultation.

Authorization to Release Medical Information
Notice of Privacy Practices
Consent for Treatment
Preferred Method of Communication
Office Financial Policy

Getting the most out of your first visit

Your first visit is very important, as it is during this visit that lays the framework to helping you reestablish your health. The more complete picture we have of your life and health history the better we can serve you.

The key to restoring health is knowing what set you up for your current issues, what were the triggering events, and what are the mediators that keep you from healing. If we can establish a health timeline we can connect the dots and hopefully unravel the mystery of why you feel the way you do.
Sample Antecedents, Triggers, and Mediators

Blank Timeline
If you can help to fill out a health timeline before your visit, it will significantly help speed up the process of restoring your health.

At your first appointment, please, come in 10-15 minutes early.
If available, please bring the following:

  • All medications and supplements.
  • Recent labs results.
  • Recent visit notes from other providers.
  • Recent imaging reports.

New Patients

New Patient Forms
Getting the most out of your first visit