Building Health From Within
Demetra Vagias   MD, ND
 
 
    
     

Forms
 

In order to maximize your time with our doctors, please fill out all forms as soon as possible and mail or e-mail back to our office. To secure your appointment, we must receive these forms at least 48 hours before your scheduled appointment. If for any reason you feel you cannot complete these forms in time, please contact us and we will accommodate you.

Mail: 2021 Midwest Road, Suite 200, Oak Brook, IL 60523
E-mail:
naturodocdemetra@yahoo.com


Forms
Authorization to Release Healthcare Information

Diet Diary

Disclosure Statement and Informed Consent

Metabolic Typing Questionnaire

Patient Health History Questionnaire

Patient Registration Form

Symptom Survey Form



 

 
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