top of page
anthonyandmarylogo copy.jpg

& Downloads

Holistic Health copy 2.png

Client Health Intake Form

You can use this form to provide general information about yourself or  family member 

Intake Form

Please use this form to provide detailed information on your family member diagnosed with PANS or PANDAS

General Women's Health Intake Form

Please use this form to provide specialist information required by the women's health program

Remote Technology
Intake Form

If you are intrested in Technology based Services then use this form

Directions for Use

Click on the image of the form that most applies to you, and then it will automatically download the form. Complete the form either online or with a black or blue pen.

You may then bring it with you for your first appointment or you may send it to us securely at



End-to-End Encryption

Messages are encrypted at all times

Messages are stored on ProtonMail servers in encrypted format. They are also transmitted in encrypted format between our servers and user devices. Messages between ProtonMail users are also transmitted in encrypted form within our secure server network. Because data is encrypted at all steps, the risk of message interception is largely eliminated.

bottom of page