Welcome to Elk Grove Naturopathic Medicine. We look forward to working with you and being a part of your health/wellness team. We offer a FRAGRANCE-FREE environment in our office to protect our staffs and patients who have chemical sensitivity. Please do NOT wear perfume, cologne, body fragrance (including lotions, deodorants), hair products, etc to your appointment. If you are bringing guests to the appointment, please advise them of our fragrance-free policy.

For New Patients

Please mail, fax or drop off completed medical history & consent forms, copies of your medical records/labs/imaging, diet diary, and any other forms as directed by our staff at least 1 week prior to your appointment date.

• Completed medical history forms
• Completed consent forms
• List of supplements/medications: include dose and frequency of dosing
• Completed diet diary/blood pressure log/temperature logs/homeopathic intake: you will be instructed by our staff on which forms to complete based on your health concerns.
• Copies of recent medical records
• Copies of recent labs/imagings

*** Emailing personal documents: Prior to emailing us any personal documents, you must have a “signed” email consent form on file with our office.  Click here for the form: Email Consent Form

All Forms

• New Patient (Adult) Intake Form
• New Patient (Pediatric) Intake Form (11 years old and younger)
• Consent forms
• Diet Diary
• Blood Pressure Diary
• Body Temperature Diary
• Homeopathic Intake form (fill out this form if you are seeing Dr. Chhun-Lum for a homeopathic remedy)
• Notice of HIPPA (You do not need to print this out. It’s for your reference)