Finding Balance

Dr. Jodi Sampson, D.C.

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Patient Forms

PLEASE CALL THE OFFICE TO SUBMIT FORMS (507) 401-2772

Patient Information Form

Health Assessment Form (Please print and fill out)

Child Neurotransmitter & Nutrition Questionnaire (Please print and fill out)

Healthy History Intake Form (Please print and fill out)

Metabolic Assessment Form (Please print and fill out)

Detoxification Questionnaire (Please print and fill out)

Informed Consent (Please print and fill out)

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