Roots & Rivers 
Naturopathic Medicine
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Roots & Rivers 
Naturopathic Medicine
  • Home
  • R&R Naturopathic Clinic
    • About Dr. Gussak
    • Medicinary & Store
    • F.A.Q.
    • What is Naturopathy?
    • Environmental Medicine
    • Apitherapy
    • Reduce Iatrogenicity
    • Intake Paperwork
    • Gallery
    • Linktr.ee
  • Services
    • Service & Price List
    • Food Intolerance Diet
    • CHT
    • Physical Medicine
    • Community Plans
    • Online Courses
  • R&R Foundation
  • R&R Basecamp
  • Contact Us

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.

Print & Download Paperkwork Here

HIPAA Privacy Practices Agreement (pdf)

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Telehealth Informed Consent (pdf)

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Consent and Code of Conduct 12.26.2024 (pdf)

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Billing Info (pdf)

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RR Patient Intake (pdf)

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PHQ-9 Depression Screen (pdf)

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GAD-7 Anxiety Screen (pdf)

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EMF Sensitivity Screen (pdf)

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ACEs Questionnaire (pdf)

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Client Testimonial Waiver (pdf)

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Good To Know (pdf)

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Cancellation and Financial Agreement updated 12.2024 (pdf)

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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

Washington state. Holistic & Natural Medicine Consultant


Copyright © 2020-2024 - All Rights Reserved.

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