Office Forms

AFWC Welcome Letter
Letter for First-time Patients with list of requested items

Patient Rights & Responsibilities
Outlines appropriate patient expectations and requirements

Payment Policy
Patient Payment & Cancellation Policy

Motor Vehicle Accident (MVA) Patient Payment Policy
Supplemental policy for patients seen as a result of a motor vehicle accident.

Release of Information
Please complete form and send to our office to request patient records from our clinic.  Please allow 5-7 business days for processing.

Authorization for Treatment of a Minor
Please complete if child is unaccompanied by a parent

4R Nutritional Management Approach
Four tips used to control nutritional intake and keep the digestive system in peak form

Cholesterol Information
Information on what cholesterol is, where your levels should be and how to control it. As well as healthy diet do’s and don’ts.

Elimination Diet
A comprehensive diet meant to clear the body of food or chemicals that may be causing sensitivity or allergies. Includes guidelines, a shopping list, and a seven day menu plan, with recipes.

Metabolism Syndrome
Information about the cluster of risk factors associated with cardiovascular disease and diabetes

Metabolism Makeover
Summary of a study done about four different diet and exercise plans that boost metabolism.

SAD Questionnaire
This questionnaire may help you decide whether to consult a clinician about depression and whether Seasonal Affective Disorder (SAD) may be your problem.

Information regarding insomnia, causes, treatments, tips and a sleep diary form

Prolotherapy Informed Consent Form
Consent form used by Dr. Fischer for patients regarding the understanding of the prolotherapy procedure and its risks

Prolotherapy – Preparation
Information on preparing for the prolotherapy procedure

Prolotherapy – After
Information on how to care for yourself after the prolotherapy procedure