Call Us: (415) 459-4313
Address: 4340 Redwood Highway
Suite D318
San Rafael, CA 94903

NEW PATIENTS

If you are a female, please download, print, and fill out the New Female Patient Forms and the Toxicity Questionnaire and bring them in to the office with you on the day of your initial Health History and Physical Examination.  They should be handwritten.  If you are a male, please download, print, and fill out the New Male Patient Forms and the Toxicity Questionnaire and bring these forms to the office with you on the day of your initial Health History and Physical Examination.  If you are currently using an anti-depressant or have ever used one in the past or have suffered from an injury to your head, please download, print, fill out and bring in the NTAF Questionnaire download as well.

 

CURRENT PATIENTS

Support For Patients Between Visits – “What happens if I do not feel well between office visits?”

This is an excellent question.  Dr. Skolnikoff has a service that he provides to his patients that is designed for patients who live out of town and are not able to drive 10 minutes to their appointment. This system is designed to support those patients who are experiencing new or unexplained health challenges between visits.  In order to receive this support please download and print out “Symptom Survey” above or you may be able to fill out “Symptom Survey Electronic” on your computer, save it, and email to us at chiro@triadofhealth.net.  Fill out this form to the best of your ability and fax it into the office at (419) 715-9257.  Dr. Skolnikoff will review the form and determine if there are any changes that need to be made regarding your health.  These changes might involve taking a nutritional supplement, coming into the office for treatment, going to see a medical doctor of some sort, being referred out to another health care provider, etc.  This service takes Dr. Skolnikoff approximately 30 minutes.  There is a $75 fee incurred for using this service if you need to make a change in your lifestyle.  You will need to provide your credit card number to the Triad Of Health Family Healing Center prior to faxing in the form.  If you need to come in for treatment and there is very little else that Dr. Skolnikoff can suggest to support you with your health on the phone, then there will be no fee assessed.  If you need to be referred out to a medical doctor then there will be no fee assessed.  If you do not need to make any lifestyle changes or receive any nutrients, then no fee will be assessed.

If you live locally and can schedule an appointment to come in for 15 minutes, this would probably be a better idea than using this service as you will be charged the same fee and can receive structural, chemical and emotional therapies rather than just chemical therapies.

New Patient Female Form

New Patient Male Form

Daily Record Of Food Intake

Digestive Screening Questionnaire

Metabolic Assesment Form

NTAF Questionnaire

Patient Schedule

Symptom Survey

Symptom Survey Electronic

Toxicity Questionnaire