top of page
anthonyandmarylogo copy.jpg

Forms
& Downloads

Holistic Health copy 2.png

Client Health Intake Form

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

Autism PANS & PANDA
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

Press the button to start the download

Fill Form

Save Form with YOUR NAME

Send the form to aamhhsllc@proton.me

Directions for Use

Click on the image of the form that most applies to you, and then it will automatically download the form.

If you decide not to fill it online then:

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 aamhhsllc@proton.me

 

 

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.

Professional Assistance

You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider.   

If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider.

If you think you may be suffering from any medical condition you should seek immediate medical attention.  

You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

© 2025 AMHHS LLC 

Illinois License Number 227.003218 Florida License Number MA96690. AADP 59083002 NPI1184387763
bottom of page