Functional Medicine Consultation Form

Transform Your Virtual Functional Medicine Practice with Paperform

Managing a functional medicine practice requires gathering deep, detailed health information before you even meet a patient. This Functional Medicine Consultation Form template is designed specifically for practitioners offering virtual healthcare visits, helping you collect comprehensive patient data that informs truly personalized treatment protocols.

Built for the complexity of functional medicine

Unlike conventional intake forms, functional medicine requires understanding the whole patient—their health timeline, environmental factors, dietary patterns, gut health, stress levels, and more. This template captures everything you need to assess root causes and develop targeted supplement and lifestyle protocols, all before the consultation begins.

The form walks patients through their complete health journey: from childhood illnesses and family history to current symptoms, food sensitivities, digestive health, sleep patterns, and stress levels. This detailed intake means you can review their case thoroughly and come to the first appointment prepared with preliminary insights and questions.

Streamline virtual consultations and follow-ups

For telehealth functional medicine practices, efficiency matters. Paperform's conditional logic shows relevant follow-up questions based on patient responses—if someone indicates gut issues, they'll see detailed questions about their microbiome symptoms and digestive patterns. If they mention food sensitivities, the form expands to capture specifics.

After submission, use Papersign (papersign.com) to send consent forms, treatment agreements, or HIPAA authorization documents for secure eSignature, keeping everything connected to the original intake. Then leverage Stepper (stepper.io) to automate your post-consultation workflow: trigger supplement protocol emails, schedule follow-up appointments, update your practice management system, and send lab test requisitions—all without manual data entry.

Secure, professional, and on-brand

As a healthcare provider, trust is everything. This template can be fully customized to match your practice's branding while maintaining the professional, calming aesthetic patients expect from their healthcare experience. Paperform is SOC 2 Type II compliant and offers robust security features to protect sensitive patient information.

Whether you're an independent functional medicine practitioner, running a holistic health clinic, or offering virtual nutrition consultations, this template helps you gather the depth of information needed to practice truly personalized medicine—while saving hours of manual data collection.

Start with this template and customize it to match your specific protocols, supplement lines, and therapeutic approach. Your patients get a thorough, thoughtful intake experience, and you get structured, actionable data that supports better clinical outcomes.