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Functional Medicine Forms
- Please complete as well as possible as your detailed personal information provides valuable information to assist with your comprehensive care. Please return forms and any other pertinent medical/health information via email (Dr.Heather@vibranthealthwellness.org) at least 1 week prior to your appointment to allow adequate time for a thorough review.
**NOTE: Ideally most of these forms will be completed through an online platform that will be emailed to you upon request.  HOWEVER, the Vibrant H&W Consent Form and PMA form (a form showing consent to natural treatment) still needs to be printed off, signed and returned to the via email or in person at your appointment. Please contact us with any questions or concerns.  Thanks!

Functional Medicine Pre-Session Form
- To be completed prior to your next functional medicine appointment, to give an update on your progress.
**Please return at least 2 days prior to your appointment via email at Dr.Heather@vibranthealthwellness.org

 

Physical Therapy Forms
-Please complete as well as possible; if you have any imaging or other medical information please bring this with your appointment. Idaho is a direct access state for physical therapy; therefore, physician referrals are not needed for an appointment but certainly welcomed.
Please return form via email at Dr.Heather@vibranthealthwellness.org or in person at your appointment. 

Telehealth Form
Aromatherapy Forms

Note: if you have already submitted a Vibrant Health & Wellness  Consent Form then you do not need to resubmit the form below. 

HIPPA Notice  

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