Balanced Body Wellness Centre, LLC offers our patient form(s) online so they can
be completed in the convenience of your own home or office.

In order to prepare for your first appointment with Dr. Firnbach, please download
and print:

patient information form
symptom survey
dental and surgical history form
patient acceptance form
detox questionaire
environmental questionaire,
medical request for records
if female, the female health questionnaire form
financial policy

Complete all the questions thoroughly. Please obtain and send all previous medical
records related to your condition to the office
before your appointment.

If you do not have recent blood work you can obtain the necessary tests without a
Medical Doctor's order at ANY LAB TEST NOW (
go to their website). You will need
to obtain the following tests: CBC, Chem profile, Lipid panel, and Thyroid panel.
The cost at ANY LAB TEST NOW for these tests together is $117.00. We may need
to order other testing such as Female Hormone Panel, Diabetes, Heart Panel etc..  
depending on your symptoms.


Send, Drop off or Fax us your printed and completed form(s) and medical tests and
records before your appointment.  Fax number is 770-425-6085.
770-425-6068
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