Online Forms

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Quantum Healing Arts offers our patient form(s) online so they can be completed it in the convenience of your own home or office. If for some reason, you are not able to complete the forms online, notify the office. In this case, you will need to arrive 15 minutes early for your appointment in order to fill forms out.

Health History Form - must be completed by all patients, except children.

Be sure to check out the contact page to see where we are located.

Pediatric Health History Required for infants and children under 12 (form may take a moment to load)

Many things can occur early in life that cause maladaptions of the nervous system.

Please print and bring this form with you to the office, or email it to info@drmariamaricich.com.

If you do not already have AdobeReader® installed on your computer, Click Here to download.

Metabolic Assessment Form (form may take a moment to load)

Fill this form out if you feel you are not 100% well! This is a basic assessment of organ and/or endocrine function. This is imperative if you experience any type of digestive problems.

Please print and bring this form with you to the office, or email it to info@drmariamaricich.com.

Neurotransmitter Assessment Form (form may take a moment to load)

Fill this form out if you experience depression, anxiety, insomnia or memory loss. This is usefull to prevent brain degeneration and/or improve emotional wellbeing.

Please print and bring this form with you to the office, or email it to info@drmariamaricich.com.

Child Neurotransmitter Form (form may take a moment to load)

Many children are showing signs of ADD, anxiety and other behavioral problems. This assesment helps the doctor determine if there is a nutritional imbalance or brain chemistry imbalance that needs support. This would significantly improve the child's adaptation to their environment.

Please print and bring this form with you to the office, or email it to info@drmariamaricich.com.

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Please print the completed form and bring it with you to your appointment

Employment application

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