Roots & Rivers 
Naturopathic Medicine
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Roots & Rivers 
Naturopathic Medicine
  • Home
  • For Patients
    • FAQ
    • Services & Pricing
    • Intake Paperwork
    • Individualized Diet
    • Hydrotherapy Suite
    • Drugless Therapies
    • Naturopathic Medicine
  • Dr. Maria Gussak, N.D.
    • About Dr. Gussak
    • Iatrogenicity.org
    • Gussak, ND Foundation
    • Environmental Medicine
    • R&R Health Facility
    • Apitherapy
  • Gallery
  • Contact

R|R Intake Paperwork

Welcome!

Before we get started, please complete this comprehensive Intake Packet and submit it at least 1 week before your appointment so that Dr. Gussak can take the time to prepare for you. This will take 45-60 minutes, depending on complexity of the case. Please use a desktop site, not a mobile app. Do not worry about downloading the Healthie App.  


You may skip anything not required, if it does not apply to you, or if you have already filled it out somewhere else.    For out of state clients, please substitute the word "patient" with "client".  


Healthie is the electronic medical records system we use. This is where uploads, documents, and electronic notes are kept. You can also use this platform to chat with the office.  We recommend having you add Roots & Rivers Naturopathic Medical Center <yourprovider@gethealthie.com> to your address book.  


Fullscript - This is the name of our Online Dispensary where you can buy products and also see your treatment plans. you will get a link to this after our first appointment together.  


We encourage you to bring any medications, supplements  & labwork with you to any appointments.  


E-email: Office@RootsAndRivers.Health 

Phone: (509)537-3660 

Fax: (833)390-1316


In Love & Service, 

Dr. Maria Luisa Gussak N.D.

Download Paperkwork Here

HIPAA Privacy Practices Agreement (pdf)

Download

Telehealth Informed Consent (pdf)

Download

Cancellation & Financial Agreement Updated 07.2023 (pdf)

Download

Consent To Treatment & Code of Conduct (pdf)

Download

PHQ-9 Depression Screen (pdf)

Download

EMF Sensitivity Screen (pdf)

Download

IFM Toxin Exposure (pdf)

Download

GAD-7 Anxiety Screen (pdf)

Download

RR Patient Intake (pdf)

Download

Client Testimonial Waiver (pdf)

Download

Good To Know (pdf)

Download

Roots & Rivers Naturopathic Medical Center

Dr. Maria Luisa Gussak - Naturopathic Physician & Medical Director

 5 S. Wenatchee Ave Suite #301 Wenatchee, WA 98801

P: (509)537-3660

F: (833)390-1316

Office@RootsAndRivers.Health


Naturopathic Doctor, licensed and insured in Washington state. Holistic & Natural Medicine Consultant. Copyright © 2022 Roots & Rivers Naturopathic Medicine - All Rights Reserved.

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