Please download the Patient Initial Intake Form from our website and take the time to fill it out as completely as possible. Click on the "Submit by Email" button on the form and follow the directions after you are finished filling out your intake form. Or save your completed form as a PDF by clicking the "Save PDF" button on the form and attach it to your email to send to info@dralysa.com.
The answers you provide will give Dr. Nguyen an understanding of you or your child as a whole person and will greatly aid in the evaluation of your health conditions.
In order to save or e-mail your completed Patient Initial Intake Form please download the latest version of the Adobe Reader software by clicking on the link below and then following the directions on the Adobe website.
Please send the form 2 days prior to your first visit. If you should experience any problems saving or e-mailing the Patient Initial Intake Form, please print a copy by clicking the "Print Form" button on the form and fax the form to the office at 1-866-931-0815. If you have a copy of any recent labs that would be helpful, bring those with you. Furthermore, bring in any medications, vitamins and supplements that you are currently taking.
For Google Chrome browsers: If you are viewing the intake form on Google Chrome and the "Submit by Email" or "Save PDF" button does not work, then you may consider reverting to the Adobe Acrobat plug-in. Type "about:plugins" in the address bar (without the quotes), hit enter, scroll down to the Chrome PDF Viewer section and click "Disable", then scroll down a little more to the Adobe Acrobat section and click "Enable".
Basic Health Insurance Questionaire
The Basic Health Insurance Questionaire form is a guide to see if your insurance company will reimburse for Naturopathic or Chinese medical care.