Patient Evaluation Form Page

1) Submit Reakiri Online Patient Questionnaire

Click on this link to submit your information

2) Submit Dr Haffejie’s Patient Questionnaire

Click on this link to submit your information

3) Vitamindrip® Account Setup & Health Survey

Click on this link to register and submit the survey

Click on this link to view the instructions

4) Metabolic Code Questionnaire

Go to http://myairsupport.com/

a) Click on Client Registration then Yes
b) Then enter ahaff for practioner id and metabolic code for package code
c) Then select ME questionnaire then click on Accept
d) Then create account and login with your account details to access the questionnaire

5) Downloadable Forms

Please download and complete the following forms as applicable

Male Hormone Deficiency Questionnaire

Female Hormone Deficiency Questionnaire

Female Estrogen Sensitivity questionnaire

OHI Patient Information Form

Share this page