Intake Forms

In preparation for your first visit, we would like you to fill out our initial Intake Form and download the second form for additional information.
When completed, you can send it to us by mail, email or fax.
Mail:
Dr. Namaya
773 Guilford Street Extended
Brattleboro, VT 05301
Email:
info@drnamaya.org
Fax:
(802) 254-1092
Please note that the information gathered is completely confidential.

From Dr. Namaya:

I am a Classical Homeopath and a board certified Family Nurse Practitioner. In addition, I have studied traditional Chinese Medicine, Western herbal medicine, and Aruyvedic. I integrate my experiences in medicine, counseling, and healing over the past 30 years and bring them to the service of my clients (patients).

I provide comprehensive compassionate wholistic medical care based on the principles of classical homeopathy. Classical homeopathy is a two hundred year old medical science that looks at the whole person: mind, body, and spirit and then determines the most appropriate form of treatment. We also incorporate the best methods from Western (allopathic) medicine and as appropriate use laboratory, x-ray and other diagnostic tools.

The initial intake that you will fill out will cover your basic medical and personal history. Try to fill out the form as completely as possible.

You and I will try to arrive at a true and in-depth understanding of you and your illness. My aim is to genuinely see what are the sources of the problem and based on that suggest a treatment. This healing requires your active participation with the suggested program.

Based on these discussions generally I make recommendations regarding your diet, changes in lifestyle, health practices, and where appropriate a homeopathic remedy.

My goal is to not only help you transform your health.

I look forward to working with you.

Sincerely,
Dr. NAMAYA