Patient Enrollment Form Fill out the form below and we will send you the consent forms and the “Living Matrix,” our online medical timeline and questionnaire. The Living Matrix provides valuable information to our clinicians and health coaches and is the first step to the Functional Medicine process. Once you get that back to us your patient representative will be in touch to help you with the rest of the process. You can always reach your patient representative in case you have a question or need help. Personal Information First Name (required) Last Name (required) Phone (required) Email (required) Date of Birth (required) Address Address (required) City (required) State (required) Zipcode (required) How Did You Hear About Us? Please select all that apply. A Family Member or FriendFacebookInstagramIFM WebsiteGoogle SearchPhysician ReferralOther Thank you!