Your Intake Form
Your Intake Form
Here is our intake form. We tried our best to keep is short and sweet... we hate filling out forms also! If we don't get some information it can be a pain for us :) Of course all data is on Secure Servers and we never release any information of any sort to anyone, ever. Just provide the information you feel comfortable providing, nothing is required. Please put your preferred first and last name in the boxes below.
Please enter your best contact phone number, preferably a text number.
Please enter your best contact phone number, preferably a text number.
Please enter your number in the spaces below.
Reminder options.
Let us know the best place to send your appointment reminders.
Address
Address
Your address here.
CC#, Ending Date and Code. This Information to Hold Appt. (Never charged prior to visit and no requirement to use the card for the visit.) No dashes or spaces. This information is not required, but due to the many requests we get, a valid card number does let us know that a person is most serious about getting scheduled.
What is the best time and day for a visit?
What is the best time and day for a visit?
Initial Visit Option
Please choose your initial visit registration, scheduling and preparation option directly below. The comprehensive visit is for the chronic case that is tired of being sick and wants expedited case. Comprehensive scheduling also allows for research and review to be pre-scheduled. Standard initial visit is for those people who want to be seen but do not have a chronic conditions or may have some other life factors affecting their choice. If you are not sure you may just pick one and we will discuss in the office. There is no fixed length of visit associated with the visit options. Visit length is determined by the case itself. You will decide if you want any testing recommended by Dr. Nenninger and that will be in addition to the visit fee. Regardless of all of this please remember that no one is ever refused service for financial reasons. If you are committed to getting better we will find a way to get you treated. :) Even if we need to split payments.
Please pick your return visit option
Please pick your return visit option
Please include and information you would like us to know before hand. Please include an referral information here and also let us know if your form has been given and special handing instructions.
Care in this practice is a highly individualized approach to healing. We have no "cookie cutter" protocols. There are no preliminary visits with office staff, and no lengthy forms to fill out. Mostly because I resented doing that when I was sick and it never helped me. We will work together from day one to figure out what is wrong and how we can change your health. I only work with those people, that appreciate, value and want to invest in this type of care. Please do a self screening for both of us and make sure that you are a person that appreciates deserves this level of commitment. I would say is it among the greatest gifts of my life that I have had the chance to work in the vast majority of time with those people that do value individualized care. I don't want my practice to be just another "system" that manages you. I know how that felt for me as a patient when I was ill and trying to recover my health. Because we take the time with each case, I think that you are more likely to get better. Having people that are sick, actually get better is the fun part of practice. However, please understand that you are not guaranteed to get better and nothing I ever say or do should be considered a guarantee. I may adjust my office policies such as email, text and phone as needed. Your signature below confirms the fact that you understand that I am not a medical doctor. I am a licensed naturopathic doctor. In NYS I function within the scope of my nutrition certification. Please note that in NYS NDs do not prescribe and can not change prescriptions. *