First visit with integrative and functional medicine doctor

If you are a new patient for an integrative and functional medicine visit, please download the male intake questionnaire (PDF) or female intake questionnaire (PDF) as appropriate. We apologize for the length of the form, but we are trying to do our best to learn everything about you that may be affecting your health.

Please ALSO complete the following:

As part of the intake process, your provider will also review your diet and lifestyle. Please record your eating behaviors over the course of three days in this three-day diet, nutrition and lifestyle journal (PDF). Before getting started, please take a moment to learn how to do the three-day food journal.

If possible, please complete all questionnaires and journal before your visit in order to give your provider time to thoroughly evaluate your responses. You may drop them off or mail to us ahead of time:

Dr. Bob Denitzio
Main Line Health Concordville
1020 Baltimore Pike, Suite 100
Glen Mills, PA 19342

Dr. Rachel Sugarman
Main Line Health King of Prussia
120 Valley Green Lane, Suite 670
King of Prussia, PA 19406

Again, thank you for your time in completing these documents and sending them in advance of your appointment. If you are unable to submit them in advance, please complete them and bring to your first visit.

If this is a pediatric visit (ages 6 to 17 years old), please refer to the forms for kids and adolescents.

A note to members of the Main Line Health Fitness & Wellness Center in Concordville

If you are a member of the Main Line Health Fitness & Wellness Center in Concordville and are coming to the office for a wellness evaluation, please complete only the following:

To schedule an appointment with Dr. Robert Denitzio, call 484.227.7858. To schedule an appointment with Dr. Rachel Sugarman, call 484.324.7311.