The Ehrhardt Center for Integrative Medicine offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our diabetes care center.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print it out and fill in the required information.
- As we continue to move toward electronic everything, we would greatly appreciate if you are able to fill out the forms electronically and would email your forms 24-48 hours in advance of your appointment to our secured email: ErnestEhrhardt@gmail.com (please see Google's gmail terms and updates regarding secure email. If you do not agree, please do not use gmail).
- Option to Fax us your printed and completed form(s) to FAX: 908-766-2772 AND bring it with you to your appointment.
- PLEASE let us know what option you chose so we can be sure to retrieve it prior to your scheduled appointment day.
- Also, please bring with you to your first appointment, or again, email preferred 24-48 hours prior to your scheduled appointment, all of your latest blood work: This should include: CBC (Complete Blood Count), HgbA1C, Lipid Panel, (LDL and HDL), Glucose, Blood Type if possible. - Please bring any dental records you have or contact your dentist to obtain your dental history and have them email (with your consent), or fax your records.
- When you bring in your urine and saliva specimens, please NOTE: All caps/tops must be securely and correctly tightened, to avoid spillage and contamination.
- ALL SPECIMENS MUST BE PROPERLY LABELED - with your Full Name, Date, Time of Collection. (We cannot accept initials or improper labeling. Please keep in mind there may be multiple specimens being tested while testing yours. We know you don't want us mixing up your specimens with someone else's, so it is your responsibility to properly label your first morning urine specimens and first morning sputum specimens. Thank you for understanding and working together with us. (Helpful: Some patients use their 'stick on return address mailing labels' and stick on the container since these are small print, and there is not much room on the container's label itself).
New Patient Health History Form - Required
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!