FORMS

Forms for Naturopath Dr. Louise Gutowski

Adult Forms:

• Intake

• Health Questionnaire

• HIPPA Notice

Pediatric Forms:

• Intake

• Pediatric Intake

• HIPPA Notice

Rev. Walter Gutowski

If you are interested in a long-distance energy healing, follow the steps below:

1. Fill out the Disclaimer and Agreement form and electronically sign it. It will be emailed to us.

2. Pre-payment is required to secure an appointment. The first session/individual appointment is $75. Follow-up 3 sessions package (one per week for 3 consecutive weeks) is $150. Pay for your Long Distance session(s) via Zelle or Paypal.

3. After payment, please call Rev. Walter Gutowski at 480-205-8020, leave a message with your name, phone number, (tell him that you filled out the Disclaimer and Agreement form if it’s your first session), and the payment receipt number, and he will call you back to schedule an appointment.

Remote Long Distance
Energy HEALING Form

Form for Remote Energy Healing Rev Walter Gutowski

FORM FOR FIRST SESSION

Disclaimer & Agreement

Pay $75 for first session/individual session.

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 $150 for 3 consecutive sessions (one per week for 3 weeks) by Zelle at 480-205-8020

Naturopathic Telemedicine Appointment

Steps to make a Telemedicine 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. Leave a message with your invoice number, phone number and she will call you back to schedule an appointment time.

Established Patient
Telemedicine Payment

Pay $75.00 by Zelle at (480)-205-0863

New Patient Fee $175.00
Telemedicine Payment

Pay by Zelle at (480)-205-0863

Contact Information

Phone:
(480)-205-0863

Hours of Operation:
By Appointment Only

Address:

Scottsdale, AZ
Serving Scottsdale, Arizona, & the Surrounding Areas

Emails:
Lgutowski9@gmail.com

drlouise@4myhealthaz.com

drwalter@4myhealthaz.com

info@4myhealthaz.com