Allergy-Nutrition Clinic
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PATIENT  INTAKE  FORMS

Print out the forms that apply to you and fill in by hand.
MAIN Intake Form
FOOD ALLERGIES
CHRONIC FATIGUE
AUTISM

Patient Forms

​Allergy & Nutrition Clinic

Local: Falls Church, Virginia 22044

Now: Prescott, Arizona 86305

Still Serving Virginia & Maryland Patients.

Cell:  703-307-1497
Calls, Email, and Zoom 
Clinic@LauraPower.com

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Copyright © Laura Power 2007 - 2021
  • Services
  • Dr. Power
  • SPECIALTIES
  • AUTISM
  • ALLERGIES
  • Forms
  • Fees/Ins
  • Contact
  • ARTICLES