Online Forms

Midwest Functional Health offers our patient forms online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, click here to download.
  • Download the necessary form, print it out and fill in the required information.
  • Bring your completed form with you to your initial consultation.

History Form & Neurotoxic Questionnaire

This form will give us an idea of your personal history and how neurotoxic your body is. Please fill it out and bring with you on your first visit.

Download & Print Form



Download the Free Adobe Reader®

Our Locations

Office Hours

Monday

8:00 am - 1:00 pm

2:00 pm - 6:00 pm

Tuesday

8:00 am - 1:00 pm

2:00 pm - 6:00 pm

Wednesday

8:00 am - 1:00 pm

2:00 pm - 6:00 pm

Thursday

8:00 am - 1:00 pm

2:00 pm - 6:00 pm

Friday

By Appointment

Saturday

Closed

Sunday

Closed

Monday
8:00 am - 1:00 pm 2:00 pm - 6:00 pm
Tuesday
8:00 am - 1:00 pm 2:00 pm - 6:00 pm
Wednesday
8:00 am - 1:00 pm 2:00 pm - 6:00 pm
Thursday
8:00 am - 1:00 pm 2:00 pm - 6:00 pm
Friday
By Appointment
Saturday
Closed
Sunday
Closed