Patients

Patient forms.

Fill out your intake form online and submit it securely, or print it and bring it to your visit or fax it to 512-892-0589. Questions? Call 512.892.0490.

Pain intake forms

For pain management, fill out one of these forms.

Neck pain intake form Fill out online Or print the PDF (20 pages)
Back pain intake form Fill out online Or print the PDF (19 pages)

Functional medicine intake forms

For hormone optimization or other functional medicine issues, fill out one of these forms.

For Dr. Dumitrescu’s concierge functional medicine practice only.

Intake form (female) Fill out online Or print the PDF (17 pages)
Intake form (male) Fill out online Or print the PDF (15 pages)

Patient forms.

Pain intake forms

Functional medicine intake forms

Other documents

First, what should we call you?

Nice to meet you, . What's the best number to reach you?

And your email?

How did you hear about us, ?

Last thing. How should we reach you to schedule your appointment?

Thanks, .