Forms

By ensuring our office receives everything in one, single, mailed package:

  • Mail COPIES of all 7 items in below list (#6 is optional) in ONE packet to 1517 Addison Street, Berkeley, CA 94703.
  • Keep originals. Single-sided copes only, please! No faxes or scans sent in email, please. We can't mail back records except CDs of imaging reports.
  • Keep records in marked sections (lab results, bone density tests, etc.). Organize by recent reports on top.
  • Please indicate on the checklist if you want the Foundations (Phase I) or Comprehensive Package (Phases I and II).
  • After we’ve received all documents (including DXAs from imaging facilities), you receive a link to schedule and pay online. Online payment is best, but if absolutely necessary you may include a check with your records.

Packet Checklist

Packet checklist

Download

Packet Questionaiire

Health questionnaire

filled out completely (10 pages)
Download

Diet Log

7-day diet diary

Filled out completely

Download
DXA instructions

How to Get DXA Reports

Instructions for getting DXA reports from the imaging facility (not your doctors' office)

Download
Bristol Food Chart

Bristol Stool Chart & Interpretation

Download
PH testing at home

PH Testing at Home

Download
24 Hour Urine-Calcium Test

24-Hour Urine Collection for Calcium

Download

Directions to Dr. Lani's Office

Directions

To Dr. Lani's Home-based Berkeley Office

Download