Informed Consent Lab The purpose of laboratory testing in our office is to evaluate nutritional, biochemical, or physiological imbalance and to determine any need for medical referral. These lab tests in our office are not intended to diagnose disease. This office utilizes conventional lab tests as well as functional medicine assessment. Functional medicine assessment is designed to assist our doctors and other healthcare providers in finding the underlying causes of your condition. Functional medicine has evolved through the efforts of scientists and clinicians from the fields of clinical nutrition, molecular biology, biochemistry, physiology, conventional medicine, and a wide array of scientific disciplines. Functional medicine evaluates the body, with special attention to the relationship of one body system to another and the nutrient imbalances and toxic overload that may adversely affect these relationships. Your medical physician may or may not agree with the necessity for – or our interpretation of – these tests. Please discuss any questions or concerns with our doctors. I have read and understand the above:PATIENT NAME(Required) First Last Signature(Required) Reset signature Signature locked. Reset to sign again CAPTCHACommentsThis field is for validation purposes and should be left unchanged. Contact wholesomehealth21@gmail.com 740.641.6574 7 N. 4th St Newark, Ohio 43055 Hours Monday - Friday 9:00 am - 4:30 pm FollowFollow Name First Last PhoneEmail Question or Comment(Required)EmailThis field is for validation purposes and should be left unchanged.