New Client Screening
Thank you for interest in the services that The Hoffman Centre for Integrative Medicine can offer you in the pursuit of your health. In order for our staff to best assist you, please complete the following questionnaire. We are honored to be part of your healing journey. Our goal is to empower you to make conscious decisions about your health and wellness. As a functional medicine practice, we work with you to identify and address the root cause or causes of your health symptoms so that you can reach your wellness goals. Our team has extensive training in functional medicine, nutrition, and with regards to Dr. Hoffman’s Seven Stages to Health and Transformation Model ™. We believe this integral approach allows for true healing. We pride ourselves in addressing the entire person, rather than simply the disease, and in creating authentic partnerships between the client and consultant. Our practice is unique in the functional medicine field due to our personalized and expanded diagnostic and treatment approaches. These are far more expansive than the services offered by a standard functional or integrative medicine clinic. Most of Dr. Hoffman’s patients have been referred by, or have already consulted with, many other functional medicine or traditional medicine practitioners without achieving the desired results. Following an intake process that takes between two and three hours, we offer a large array of diagnostic test options, test recommendations, test interpretations, and personalized wellness programs. Educating patients on the underlying biochemical pathways that contribute to their health issues is paramount in our approach. Whether you’re newly diagnosed with a health condition or have been on your health journey for many years and are stalled in your efforts to reach true wellness, we invite you to learn more about our services. We look forward to helping you achieve vitality and optimal health. This short survey provides us with a snapshot of your needs and desires related to your anticipated outcome. Upon completion of the survey, one of our patient care assistants will contact you to discuss our services and help you determine how we might best attend to your needs. Please note the questions marked with an asterisk are mandatory.
Email address *
First Name *
Last Name *
Gender *
Date of Birth *
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CONTACT INFORMATION
Street Address *
City, State, Country *
Postal Code
Phone
Mobile Phone
Are you completing this survey for yourself or on behalf of another person? *
We'd love to know how you found us or who referred you. Please first choose a category and then provide us the specific information. *
Please specify
What is the name of the person who referred you? What search term(s) did you use? OR Which social platform, video, summit, event, or website referred you?
What are your main goals in seeking functional medicine consulting services at The Hoffman Centre? *
Please be very specific so that we can best align your needs with the most appropriate patient care assistant.
What are your top five symptoms? *
MEDICAL HISTORY
Do you have any known health or medical conditions or diagnosis that we should be aware of when helping you to find the best care? If so, please complete the information in the following section.
Current Diagnosis
Please list Diagnosis and Date of Onset
Past Diagnosis
Please list Diagnosis and Date of Onset
Medical Diagnosis Notes
Are you currently taking any pharmaceutical prescription medication? *
Have you consulted with medical specialists, naturopathic doctors, or worked with any other healthcare providers?
This includes chiropractors, dentists, acupuncturists, psychologists, or dieticians. If so, PLEASE LIST BELOW: The Specialist TYPE, Specialist NAME, and Approximate Date
Have you had surgery in the last two years?
If so, PLEASE LIST EACH: Surgery, Date, and Reason
What have you tried so far, such as diets, testing, or modalities, to meet your goals? *
Please check all that apply.
Required
What is the most frustrating aspect of your symptoms or health condition? *
Please check all that apply.
What is your level of readiness and commitment on a scale of 1 to 10 *
To significantly modify your diet and lifestyle, take supplements as recommended, engage in functional medicine laboratory testing, and explore your lifestyle practices and possibly psychological issues in order to make any potential life-transforming changes?
Lowest
Highest
Which of the following items are currently part of your diet, in any amount? *
Please select all that apply.
Required
How prepared are you to make radical revisions to your dietary approach? *
In order to achieve optimal nutritional levels while lowering any potential inflammatory triggers.
Any food or environmental allergies? *
Please LIST EACH Food/Environmental allergy AND the Reaction you experience
What percentage of your meals are currently prepared at home? *
Over the last few years, how much do you estimate you've financially invested in trying to solve your health issues? *
Consider such aspects as copays, medications, supplements, programs, and your time.
Please note that this individualized functional and integrative medicine approach has resulted in incredible health transformations for clients in as little as four to six months. Sometimes it may take much longer depending on the age of the patient, the length of time they’ve been ill, the number of organs or biochemical pathways that are affected, and genetic predispositions. Other determining factors include concurrent mental health challenges, defenses and types of resistance faced by the patient regarding self-empowerment, and self-advocacy in doing what it takes to get well, and the support services that are available. One of the major challenges facing patients with complex illnesses that feel as though they’ve been everywhere and seen everyone and who now want a functional or integrative medical approach, is that this approach falls under the mantle of private medicine. In fact, it’s illegal to charge the Canadian healthcare system for what they term an alternative or complementary medicine approach. Dr. Hoffman refuses to manage patients based solely on symptoms and the name of a disease. Furthermore, most patients with complex presentations from other practitioners have very often had woefully inadequate workups and have fallen far short of the number of laboratory tests that are required in order to develop a comprehensive diagnostic and therapeutic program. Consequently, in order to achieve maximum insight into disease or symptom processes, Dr. Hoffman conducts extensive laboratory testing with American and European laboratories, which aren’t covered under any healthcare plans. In addition, in his diagnostic workup Dr. Hoffman investigates inherited family system trauma, early developmental trauma, stress responses, psychological profiles and defense mechanisms, in addition to brain and mind/body determinants. This diagnostic approach requires an average emotional and financial investment of between $10,000 and $15,000 in laboratory test costs alone. These costs may be significantly higher if there are many symptoms, multiple diagnoses, and multiple visits to numerous practitioners. Dr. Hoffman will closely study every consultation conducted by previous practitioners, as well as testing carried out within the previous three months and whatever treatments plans have been initiated to date. We require that you assist our staff in compiling a comprehensive past medical dossier. We regret that current medical approaches to illness do not, at this stage of medical knowledge and funding, financially support these programs.
Are you aware that this is a private healthcare facility, with private lab tests and treatment costs that are not funded by Alberta Health Care insurance, other provincial health care insurances, or United States insurance policies? *
(Private insurance companies and/or health trust accounts may cover some of the costs. Making enquiries with these companies and the submission of invoices to them will be your responsibility. Health funding loans are also available from individual companies and banks).
Patients usually visit the Hoffman Centre after having exhausted their options following visits to other health care providers, including those that are traditional or integrative, alternative, naturopathic, or functional in nature, and remain symptomatic with unresolved issues. In order to provide the answers patients require that haven’t been provided by previous assessments, extensive functional medicine laboratory tests will be required. This is especially the case if your presentation is complex, long-standing, and involves multi-systems.

At the Hoffman Centre, we’re unable to provide insights not previously uncovered by previous workups if we can’t measure the full extent of a patient’s biochemical, structural, toxicological, mind-body, emotional, and brain imbalances that weren’t investigated previously. The number of tests required may be considerable, with between four and fifteen different tests ranging from $500 to $3,000 per individual lab test. Please note that individuals with singular issues, such as hormonal imbalances, will not require such an extensive workup.

In every circumstance we attempt to limit testing to the absolutely essential procedures that will provide insights into your disease or symptom profile that are uncovered at your initial half-day appointment. The number of tests required to obtain an assessment of your health most often depend on:

• Your age
• The length of time experiencing symptoms
• The extent of bodily organs involved

Please note, it’s impossible to provide a quote regarding which tests you’ll require without a thorough history and timeline of illness being obtained at your initial appointment, either in-person or on Zoom or a similar online video platform. After this initial meeting to learn more about your history, you’ll be provided with a list of potential tests that will assist in uncovering the potential causes and imbalances, including antecedents, triggers, and mediators, of your symptom profile. Many patients erroneously believe that their symptom complexes or conditions are due to one single factor. We have found through many years of experience, that this is very seldom the case. Furthermore, we stand by our clinical principles of not diagnosing or treating a patient without measuring objectively what factors may be contributing to their symptom complexes. Our staff members that answer phone enquiries will be unable to provide a pre-appointment specific quote for these very reasons. Please note that in every case we attempt to work within a patient’s budget and payment timeline.
Are you financially prepared to complete the tests required to provide insights that were not previously uncovered? *
Please be aware that your credit card will be charged for your initial appointment at the time of booking and not the day of your appointment. We are not able to reserve an appointment time without payment. Please acknowledge. *
Are you able and/or prepared to take action and emotionally and financially invest in yourself to achieve your health goals? *
Comments
We’re committed to working with individuals who are dedicated to their health and ready to receive support on their individualized journey to wellness and healing. We’re uniquely poised to uncover and unlock the evolving protocols that will deliver the results you've been seeking.
In two or three sentences, tell us something about yourself or concerning your health history *
This will help us get to know you before we take any further steps to further explore the details of your concerns.
Please provide an email address if you would like to be signed up for our newsletters.
Today's Date *
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Thank you for taking the time to provide us with this important information. Once completed, please click SUBMIT and we will contact you within 24 to 48 hours.
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