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Functional Medicine Paperwork

Please set aside some time to complete the new patient packet below. Please note: It may take an hour or so to complete the required paperwork. This information will provide the doctor with a better picture of your past and current health and will greatly increase the efficiency of your visit. If you do not have access to a printer, please call the clinic and we will be happy to send you a copy in the mail. Be sure to complete steps 1 and 2 before your first visit.

1. Print and complete the appropriate new patient packet below.

2. Send the completed new patient packet to us at least 24 hours before your appointment.


9:00am - 5:30pm

9:00am - 5:30pm

9:00am - 5:30pm

9:00am - 5:30pm

9:00am - 5:30pm

9:00am - 11:00am

One Source Wellness & Chiropractic
13730 West Greenfield Avenue
Brookfield, WI 53005
(262) 244-7600

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