Complete Your Health History Questionnaire

To ensure we provide the best possible care, please fill out the functional medicine history questionnaire before your visit. This process typically takes 7-15 minutes, depending on how much detail you choose to provide. This information is crucial for your provider to determine the necessary tests and focus areas for your health. The sooner you complete the form, the more time your provider has to review and make notes.

Access Your Questionnaire

You can fill out the history questionnaire right here on this page. Additionally, questionnaire is allowing you to return and complete it at your convenience if you need to pause.

Thank you for your cooperation. We look forward to helping you achieve optimal health with MITA Functional Medicine.