Welcome to our clinic!
Please download this document to your computer and fill it out entirely. When completed, please either print it out and bring it to your initial visit or email it to assistant@wellnesswithinyou.org.
Select either the New Patient Paperwork or, for children 10 years and younger, the Pediatric Intake Form.
New Patient Paperwork
Pediatric Intake Form
What To Expect
Prior to your New Patient Examination, we will provide you with an Intake Form and a Metabolic Assessment form. These forms need to be completed before your scheduled appointment time. The information you provide on these forms equips us with the necessary contact information, current and past health complaints, and details on your current symptoms.
At your New Patient Examination, Dr. Schielke will take a full history and talk to you in detail about the nature of your health concerns. She will then perform her comprehensive exam. This exam usually lasts about 40 minutes, and will likely need to be rescheduled if you are late or arrive with your paperwork unfinished.
A Report of Findings follow-up appointment will be scheduled for at least a day after your exam. We welcome spouses and partners to attend you at this appointment, as we know making changes for better health often requires support and understanding from loved ones.
At the Report of Findings, the doctor will provide a detailed written report of the significant/relevant findings from the examination. The doctor will be available at this time to answer questions about the findings and will explain whether she feels she can help you, and if so, how she would like to proceed with treatment. The Doctor will line out a treatment plan with visit recommendations and the costs associated with them. After committing to the doctor’s recommendations, treatment can begin at this appointment. This follow-up usually lasts about 40 minutes.