$995 for the HCR+/FMEC Platform $150 per month
Please complete the following forms. A PDF copy of completed forms will be emailed to you and SFM, (password protected). Upon review of the forms, SFM will contact you.
Each form redirects to the next form when finished, but if you don’t complete all the forms at once, you may return to this page to start the next form.
Virtual private networks (VPNs), browser pop-up blockers and anti-virus software my prevent the online forms from submitting. It is highly recommended to turn off VPNs prior to starting the forms.
Completion of Application does not establish a provider/patient relationship with SFM. Each of the forms below redirects to the next form until the IFM MSQ is complete, so you will only need these links if you do not complete all of the forms at once.
- Applicant Disclosures
- Complete Online (Click Here)
- Applicant Health History
- Complete Online (Click Here)
- Applicant 24-Hour Diet Recall
- Complete Online (Click Here)
- Applicant IFM MSQ
- Complete Online (Click Here)
SFM’s Functional Medicine Program patients are responsible for a one-time payment of $995. This payment is due three days before the scheduled visit. This charge is not billed to insurance. Functional Medicine Program patients are also responsible for $150 per month to access the FMEC Platform.