Please print and complete each of the following forms before you come to your first office appointment. Having these forms completed is essential in order to optimize your time spent with your doctor.   Please also bring copies of the most recent blood work, scans or tests completed by your MD or other health care providers. You can also complete the Release of Records form (for each pertinent health care provider) and bring to your initial visit. This form will then be faxed on your behalf to receive copies of lab results required or discussed. Required:

  • Release of Records

Release of Records

  • First Office Visit Intake Form (click on the appropriate form below)

Dr. Fleury Adult Intake form
Dr. Fleury Pediatric Intake Form
Dr. Marcoux Adult Intake Form
Dr. Marcoux Pediatric Intake Form
Dr. Pihowich Adult Intake form
Dr. Pihowich Pediatric Intake Form
Dr. Pihowich Laser Intake Form
Osteopathy Intake Form
Colon Hydrotherapy Intake Form
Room to Breathe Client Intake Form
Room to Breathe Return Client Session Prep
Room to Breathe Somatic Breath Therapy Agreement
Intravenous Intake Form
Intramuscular Intake Form

Other Forms

Return Visit Follow Up Form

Environmental Toxic Exposure

Patients Only

Patients receive a password to log in to this patients-only area with additional resources

Patient Login