Santa Barbara Wellness for Life offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- If you do not already have AdobeReader® installed on your computer, click here to download.
- Download the necessary form(s), print it out and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Intake Forms - Required
Welcome to our clinic! These forms are designed to help us get to the cause of your current health problem as quickly as possible. The more detailed and accurate you are, the better care we can provide. Your overall health is just as important to us as your current major complaints. No symptom is insignificant. The more you tell us, the more we will be able to help you achieve your health goals.
Personal History (All patients)
Symptom Survey (Dr. Dale, Dr. Mark)
Metabolic Assessment (Dr. Hall)
MPI Cognition Questionnaire (Bredesen protocol patients only)
If you have any trouble downloading the online forms, or are unable to print them, please give the office a call at 805-687-0533. We can mail you the intake forms if necessary, or you may stop by the office to pick them up.
Download the Free Adobe Reader®