Francis Holistic Medical Center

N. Thomas LaCava, MD, Medical Director                                             Treating the Cause of Complex Chronic Illness

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Contact Us

If you are interested in setting up an initial comprehensive visit with Dr. LaCava, please contact our office at (508) 854-1380. 

These appointments are scheduled for an hour in duration, but please plan to be here for approximately up to two hours.  The initial visit requires questionnaires, checklists, and summaries that need to be completed by the patient (or parental guardian, if the patient is a minor).  These forms can be sent to you by mail, or you can download them here on our website below.

The forms need to be completed in full and returned to our office for receipt BEFORE your appointment.  We highly recommend that you have these documents returned to the office AT LEAST ONE WEEK prior to your visit.  Please note, your inability to comply with this request will result in your loss of valuable time spent with the physician.  For more information, or if you have questions, please contact our office and we will be happy to assist you.
 
FORMS

To download the forms required for your initial visit, please click on the links below.  These documents are Adobe (.pdf) files, and thus require a free program Adobe Reader or Adobe Acrobat to view.  If you are experiencing problems viewing these forms, please contact our office at (508) 854-1380.

ADULT  patients (persons 16 years old or older) seeing Dr. LaCava for their initial visit should complete forms  4, 5, 6, 7, 8, and 9.

The responsible party for PEDIATRIC patients (persons 15 years old or younter) seeing Dr. LaCava for the initial visit should complete forms 11, 5, 6, 7, 8, and 9.

For a person whose symptoms Do Not vary from day to day or month to month and who does not believe the symptoms are triggered by exposures, please complete form 1 or 2, as well as completing forms 4 or 11 and forms 5, 6, 7, 8, 9.

For a person whose symptoms Do vary over time, then please complete forms 3 or 10, as well as completing forms 4 or 11 and forms 5, 6, 7, 8, 9.


1) Initial Health Survey for Men

2) Initial Health Survey for Women

3) Adult Allergy Database & Health History
(for patients 16 years old and older)

4) Food Frequency Questionnaire (Adult)
(for patients 16 years old and older)

5) Chronological Summary


6) Patient Registration
 
7) Authorization
 
8) Letter Regarding Laboratory Testing
 
9) Alternative Laboratory Testing Kits Waiver

10) Pediatric Allergy Database & Health History
(for patients 15 years old and younger)

11) Food Frequency Questionnaire (Pediatric)
(for patients 15 years old and younger)

12) Chronological Summary

13) Patient Registration
 
Print each item indicated, please complete and return them to our office as soon as possible.  

Should you need to reschedule or cancel your appointment for any reason, you must do so at least three business days prior to your appointment. 


Appointments are scheduled by calling the office during normal business hours.

In the future, we may allow patients to schedule their own appointment via a patient portal.

We provide integrative, functional medicine in Central Massachusetts in the Worcester area. Many of our patients come from Boston and the Metrowest Boston area as well as all areas of Massachusetts and the other New England states.

(C) Copyright 2013 and 2015 Francis Holistic Medical Center, Last Modified: August 19, 2015 at 12:30 pm