Schedule: Monday - Friday 09:00 - 17:00

Appointments: 1-203-275-6666

Patient Intake Form

Welcome to Integrative MD!

Thank you for making your first appointment! We are excited to meet with you and help you on your health journey.

The first step for us to get to know you is the intake form. You’ll get the most out of your appointment by telling us your story before we meet in person for the first time. This will greatly facilitate our conversation about your health goals and challenges during your appointment. For that reason, your intake form is very detailed and is one of the most important aspects of your first appointment. Please fill it out carefully following these instructions:

  1. This intake form must be filled out and saved in Adobe Reader. Download it to your computer first. DO NOT fill it out in your browser. You can get Adobe Reader for free by clicking here.
  2. Please give yourself enough time. You are telling us your story, and the more we know about you, the better we can help.
  3. If you are not sure how to answer, leave a question mark next to the question and move to the next item.
  4. Save the form to your computer. Save frequently as you go through the form answering the questions so you don’t lose your answers.
Kindly send us back the completed form at least 2 days prior to your scheduled appointment. We need time to review it to be ready to meet you. The most secure way to send us the form is through Patient Portal. Go to Patient Portal –> Documents –> Share File.

By now you should have received an invitation to register in Patient Portal. Please contact us if you have not received the invitation or require further assistance.

If you are comfortable sending this information through email, you can email the completed form to

Please DO NOT print out and bring us a paper copy. We can ONLY process documents in the digital format.

So click the button below to download the intake form and let’s get started!