Download Intake Forms Prior to your first visit, there are 3 things you will need to prepare for your visit: - Intake forms for you to fill out for yourself or your child.
You can download these 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. - Bring in any medications, vitamins and supplements being taken.
- If you have a copy of recent labs, bring those as well.
If you feel that your concern may be diet-related, please consider printing the diet diary instructions and filling out diet diary form below. Thanks you for your cooperation and effort to create the most effective visit for you possible. Download intake forms: Adult (PDF) Child or Adolescent (PDF)
Diet Diary Forms:Diet Diary Instructions (PDF) Diet Diary (PDF)
Other Forms:Records Release (PDF)
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The gem cannot be polished without friction,
nor a person perfected without trials.
Chinese Proverb |
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"When I came to see Dr. Sam it had been over 3 years since I had had a period. During those 3 years I went to multiple doctors including several gynecologists and internists, and an endocrinologist. On several occasions I was placed on either synthetic or bioidentical hormones with no success. As a last resort, each of these doctors recommended that I go on birth control pills to bring my period back. I was uncomfortable with that option as I felt it would only mask the bigger problem; my amenorrhea was a symptom that my body was out of balance.
Along with acupuncture treatments, Dr. Sam treats me with chinese herbs, supplements and has counseled me on my diet. He takes the time to patiently listen to my concerns and extensively answers any questions that I have. I feel that he sees my symptoms as being unique to my own experience and treats me in accordance to this. He shows a genuine concern for my health and well being.
After 4 months my period has come back! I finally feel that my body is healing.
I am very grateful to have found Dr. Sam."
LP |
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