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Integrative Medicine Case Study

Thank you for contributing to the progression of integrative medicine by sharing your case study.  Please complete the short form below.  Your information will not
be published or shared without prior consent. 

You will be contacted if your case study is selected or if you elect below that you are interested in sharing your case study publicly.  Without consent, your
submission will remain anonymous in our database, but is still encouraged and appreciated to help us learn and grow our application of integrative medicine.
 
I.  Case Report Introduction:
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II. Patient Profile:
Sex at Birth
Ethnicity  
 




 
III. Chart Review: 
 
Past Medical History (PMH) - Specify relevant history

 
Review of Systems (ROS) - As recorded from most recent medical visit


















 
Physical Examination (PE) - As recorded from most recent medical visit.
IV. Laboratory Data: 
 
V. Treatment Protocol/Intervention:

 
VI. Clinical Discussion of Outcomes:
 
 
VII. Case Study Sharing:
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*Are you interested in participating in sharing this case study in additional formats (e.g., speaking engagements, interviews, and/or publications)?
 
 
VIII. Additional Comments: 


Thank you for sharing your case study and for contributing to the future of integrative medicine.
If you have questions or additional comments please email info@integrativeinc.com.


 
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