To become a patient at Southwest Functional Medicine please
1. Download the forms below
2. Email info@swfunctionalmedicine.com or fax (702-227-7113) us the completed forms
3. Set up an appointment with our staff
- Office Policies
- New Patient Male Intake Form
- New Patient Female Intake Form
- New Patient Child Intake Form (Development Delay/Autism/ADHD)
- New Patient Child Intake Form (Well Child or Sick Child)
- Medical Symptom Questionnaire (MSQ) – For existing patients only