New Patient forms

 

A (Before your 1st appointment)   Click here to download all 5 forms together  Bring these with you to your first appointment.

The 5 Individual New Patient Forms

• Find the Cause of Your Weight Problem—Body Shape Quiz

• Weight Loss Difficulty Questionnaire

• Most Commonly Reactive Foods

• Body Mass Index

• Metabolic Assessment Form (MAF)—complete sections VI & VII only


 

Weeks 1–8: Complete Program

B (Complete 8-Week Program – Click here to download 1 single pdf)

Individual pdfs for 8-Week Program

Week 1

• Stapling Instructions for pdfs

• Diet Diary (make 8 copies)

• Hunger Is All in Your Head

• Neurotransmitter Assessment Form (NTAF)

• Glycemic Index

• Blood Test Instructions

• Insulin Resistance Evaluation

Week 2

• Eight Physical Causes of Weight Problems

• Liver Enhancement Program

Week 3

• QRA Nutrition Testing Chart (don’t fill out)

• First Time Evaluation

• Balancing pH

Week 4

• Metabolic Type I

• The Blood Sugar Diet

Week 5

• Metabolic Type II

Week 6

• Metabolic Type III—Chinese 5 Elements Questionnaire

• Chinese Five Elements Diet

Week 7

• Metabolic Type IV—Ayurvedic Body Type Evaluation

• Ayurvedic Diet

Week 8

• Eat and Avoid List

Special Diets

• SD_A-O

• SD_TL

• Dr. Stone’s Purifying Diet

• Changes that Occur During the Purifying Diet