ONLINE FORM

Midwest Functional Health offers our patient forms online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, click here to download.

  • Download the necessary form, print it out and fill in the required information.

  • Bring your completed form with you to your initial consultation.

History Form & Neurotoxic Questionnaire

This form will give us an idea of your personal history and how neurotoxic your body is. Please fill it out and bring it with you on your first visit.

Download & Print Form

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WHAT TO EXPECT

At Your Consultation, we will review your neurotoxic questionnaire that will be sent to you prior to your appointment. We will also perform a meta-oxy urine test, that will look for cellular inflammation, as well as a Visual contrast sensitivity test to look for bio-toxins. In your 2 hour consult we will thoroughly deep dive into your health history to look for signs of hidden infections, heavy metal exposure or bio toxin exposure. We will then assess all the information and determine if any further testing is needed to curate a program and coaching to get to the root cause of your health issues and restore your health!

Fix the cells through the 5 R's

1. Remove the Source - removal of any interferences that are blocking the body from being well.

2. Regenerate - the cell membrane

3. Restore - cellular energy

4. Reduce - inflammation and oxidative stress

5. Reestablish - methylation

Open the Detox Pathways

The liver, kidneys, gut and lymph must be opened and detoxed as a preparatory step to cellular detox.

True Cellular Detox

We work to clear toxins all the way out of the body and brain.  This process must be performed correctly to be safe and effective.

Functional Protocols

An essential part of the program, specifically designed and based on each individual case, and adjusted throughout the entire protocol.

During the program we empower you and teach you how to allow your own body to heal itself and have lifelong true health.

HEALTH RESOURCES

The following resources have been assembled to provide you with wellness care.

Chiropractic Care

https://www.dekalbcc.com/

Weight Loss & Health Coaching

https://trueweightlosssolution...

PAYMENT OPTIONS

The Midwest Functional Health offers a variety of programs.  These programs are customized to each patient and their health challenges.  Because of the vast array of health challenges people face these days, the programs vary greatly in coaching, testing, supplementation, and length.  A comprehensive consultation is required to determine which program is appropriate for each patient.

Payment Option #1 *One time Payment - SAVE 10%

Payment Option #2 *Three-six Monthly Payments (depending on the program)

Payment Option #3 Deferred Interest/Zero (0%) Financing with Care Credit for 18 months

Payment Option #4 Automatic Monthly Credit Card Billing for 12 months

*Some HSA's accepted.