New Patient Forms
|
Please print out the forms, fill them out, date them with the date of your first visit and bring them to your first appointment. Completing them beforehand will save you time during your visit with us. |
Forms for Naturopath Dr. Louise Gutowski
Adult Forms:
| • Intake | • Health Questionnare | • HIPPA Notice |
Pediatric Forms:
| • Intake | • Pediatric Intake | • HIPPA Notice |
Forms for chiropractor Dr. Walter Gutowski
Forms:
| • Intake | • Health Questionnaire | • HIPPA Notice |
Remote Energy HEALING Form
Form for Remote Energy Healing Rev Walter Gutowski
Form:
Please print out the form, fill it out and
fax to 480-315-6503 or
scan in completed and signed form and
e-mail to RevWalterGutowski@gmail.com
Payment for remote Energy Healing
To pay for long-distance energy healing appointments
please click below.
Then call Rev. Walter Gutowski at 408-205-8020.
Pay $180.00 by Zelle at (480) 205-8020
Naturopathic Telemedicine Appointment
Steps to make a Telemedicine Video Appointment:
1. Make payment to Associated Health Care, LLC and get a receipt that will have an invoice number, which you will give to Dr. Gutowski. Your credit card statement will say: Associated Health Care, LLC
2. Once you have paid, call Dr. Louise Gutowski on her cell (480) 205-0863, give her your invoice number and schedule an appointment time.
3. When you make your appointment, you will be instructed on how to do the video call.
Established Patient
Telemedecine Payment
Pay $75.00 by Zelle at (480)-205-0863
New Patient
Telemedecine Payment
Pay $180.00 by Zelle at (480)-205-0863
Contact and Directions
Phone:
(480) 315-6500
Hours of Operation:
By Appointment Only
Address:
8149 N 87th Place
Scottsdale, AZ 85258
Serving Scottsdale, Arizona, & the Surrounding Areas
Emails:
drlouise@4myhealthaz.com
drwalter@4myhealthaz.com
info@4myhealthaz.com
Directions
From 101: Exit at Via de Ventura and go West. Pass the Pima light and turn right at the next light, Via de Negocio (post office is on the corner). Go two blocks and the road dead ends. Turn right and the 8149 building is directly in front of you. Park in visitor lot or street parking.
From Hayden: Turn east on Via de Ventura (Bank of America™ is on the corner). Go to the first light, Via de Negocio, and turn left (post office is on corner). Go two blocks and the road dead ends. Turn right and the 8149 building is directly in front of you. Park in visitor lot or street parking.
Note: The doors automatically lock promptly at 5:00 p.m. If you arrive after 5:00 p.m., contact the office at (480) 315-6500 (let it keep ringing) and we will let you into the building.
