HEALTHY LIVING BY DESIGN
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  • Home
    • About Me
    • 212-949-3900
    • Dr. Cheung Chats
  • Services & Forms
    • Patient Forms
    • Special Programs
  • Contact
  • Vitamin Orders
  • What is Functional Medicine
  • Patients Say
  • Lectures and Workshops
  • Clinical Testing
  • Live Laugh Love
  • Videos
  • Help
  • Food Plans

Forms for Patients

*Forms for New Patients
Click on each form below to download the necessary forms to start your health and lifestyle assessment. 

2019_new_pt_history.pdf
File Size: 293 kb
File Type: pdf
Download File

​    * New Patient Forms 

7_day_lifestyle.pdf
File Size: 6093 kb
File Type: pdf
Download File

* 7 day Food and Lifestyle Survey

notice_of_privacy_practices.pdf
File Size: 83 kb
File Type: pdf
Download File

* HIPAA Disclosure and Consent (please read and sign)

waist_to_height_ratio_copy.pdf
File Size: 75 kb
File Type: pdf
Download File

* Height and Weight Measurement (for weight loss)

medical_questionnaire_form.pdf
File Size: 181 kb
File Type: pdf
Download File

* Medical Symptom Questionnaire

gi_questionnaire.pdf
File Size: 52 kb
File Type: pdf
Download File

      *Gastro-Intestinal Questionnaire     

detox_questionnaire_met1229_.pdf
File Size: 40 kb
File Type: pdf
Download File

      *Detoxification Questionnaire    


update.pdf
File Size: 31 kb
File Type: pdf
Download File

Update Form: needed every 3 months.
cleansing_and_supplement_sched.pdf
File Size: 30 kb
File Type: pdf
Download File

Cleansing and Supplement Schedule

SERVICES

  • Consultations by  Phone, Skype or FaceTime
  • Clinical and Functional testing
  • Anti-Aging programs
  • Gastro-Intestinal work-up
  • Body Mind Lifestyle coaching
  • Personalized Health programs
  • Corporate Wellness Programs

 Body

Mind

and​

 Lifestyle

Medicine

HEALTHY LIVING LECTURES

  • Obesity
  • Diabesity
  • MicroBiome diversity
  • Peri and Post Menopause
  • Healthy Sex after 40
  • CardioMetabolic Health
  • Allergies, Gluten and Yeast
  • Autism Spectrum
Available for:
Inspirational speaking engagements for small and large groups

​I can design a program to fit your individual needs.
Take an action step today!  Begin your first step to health and wellness.
Call: 212-949-3900

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