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Welcome!
Adobe Reader -Get your free copy of Adobe Acrobat Reader! We post our downloadable documents as
Acrobat files. If you do not have Acrobat, download it now so you can view and print our supplement order
forms, Audio/Video order forms, educational brochures, flyers, booklets and newsletters.
Acrobat files. If you do not have Acrobat, download it now so you can view and print our supplement order
forms, Audio/Video order forms, educational brochures, flyers, booklets and newsletters.
These forms are necessary for both new and returning patients who would like to be evaluated at the clinic.
The following five (5) documents are included in the new patient packet and must be reviewed and completed
before you come to the clinic. This process should be started at least seven (7) days prior to submitting
paperwork.
The following five (5) documents are included in the new patient packet and must be reviewed and completed
before you come to the clinic. This process should be started at least seven (7) days prior to submitting
paperwork.
Health Education
Audio - Video Catalog - This booklet includes descriptions of the educational titles listed on the Audio-Video
Order Form.
Audio - Video Catalog - This booklet includes descriptions of the educational titles listed on the Audio-Video
Order Form.
Monthly Nutrition and Lifestyle Log - A concise form that allows you to keep track of the most important aspects
of your program and track your progress.
of your program and track your progress.
7 Day Diet Summary- Summarize your food intake for seven days. This can be done the week before, during
or after your blood draw.
or after your blood draw.
Lifestyle and Symptom Survey - Answer questions that allow Dr. Brouse to quickly and concisely capture your
current symptoms and health history.
current symptoms and health history.
Current Supplement List- List all Vitamins and Minerals that you are currently taking each day.
Privacy Form - Privacy policy information for you to sign and date in acknowledgement.
Authorization for Services- Complete your name, address, phone number, etc. and sign and date form to
accept terms for report evaluation.
accept terms for report evaluation.
Build a Better You Forms (B.A.B.Y.)
The Build a Better You program is designed for new or returning participants who would like to be evaluated
long distance. This program is available anytime and is accomplished through a local lab near your home, the
report sent by mail, and consults over the phone. The following five (5) documents are included in the Build a
Better You packet and must be reviewed and completed before your report can be evaluated. This process
should be started at least seven (7) days prior to submitting paperwork.
The Build a Better You program is designed for new or returning participants who would like to be evaluated
long distance. This program is available anytime and is accomplished through a local lab near your home, the
report sent by mail, and consults over the phone. The following five (5) documents are included in the Build a
Better You packet and must be reviewed and completed before your report can be evaluated. This process
should be started at least seven (7) days prior to submitting paperwork.
7 Day Diet Summary - Summarize your food intake for seven days. This can be done the
week before, during or after your blood draw.
week before, during or after your blood draw.
Lifestyle and Symptom Survey - Answer questions that allow Dr. Brouse to quickly and
concisely capture your current symptoms and health history.
concisely capture your current symptoms and health history.
Current Supplement List - List all Vitamins and Minerals that you are currently taking each
day.
day.
Privacy Form - Privacy policy information for you to sign and date in acknowledgement.
Patient Forms
Intake Form- Complete your name, address, phone number, who referred you, etc.
Support Forms for Ongoing Progress
You may access a New Patient Packet or Build a Better You packet through the mail, fax or on-line. Before
starting a program, please read A Nutritional Approach to Health Recovery - This booklet of information
describes the care provided at Sunnyside Health Center. This is a must read for all new patients interested in
coming to the clinic.
starting a program, please read A Nutritional Approach to Health Recovery - This booklet of information
describes the care provided at Sunnyside Health Center. This is a must read for all new patients interested in
coming to the clinic.
Patient Supplement Sheet - Track supplement intake at the start of your program and any changes
thereafter.
thereafter.