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Required Information

When you come in for a visit with our integrative doctor, we ask that you bring with you the following:

  • a list of your concerns (to ensure you don't forget to discuss all your health issues)
  • make a list of (or preferably bring) all supplements you are currently taking
  • make a list of (or preferably bring) all medications you are currently taking.
  • keep a diary or journal of what you are eating on a daily basis for a week so the doctor can have an idea of your current nutritional habits.
  • copies of any recent lab results and or tests

Required Information

Required Forms available for print

  • Each patient is required to complete a Welcome Form with your contact, insurance and health history information. Please bring your insurance card and photo ID at the time of your visit. Copies will be made. Although Dr Adrian does not accept insurance and is self pay, your insurance information is required in ordering lab tests and ordering medication as benefits may still apply.
  • Each patient is required to sign an Authorization to Treat.
  • Each patient is required to sign a Privacy Policy.
  • Dr Adrian does not accept insurance and has opted out of Medicare. If patient is eligible for Medicare, patient must complete the Private Contract and Financial Policy before seeing the doctor and agrees NOT to submit any claims for the visit to Medicare or any Medicare Advantage plans.



All forms are available as online fillable forms:

Authorization to Treat

Welcome Form

Privacy Policy

Medicare Privacy Policy & Financial Policy


Visit our complementary medical doctor if you are a resident of Hershey, Lancaster, Palmyra, Reading, Chambersburg, Elizabethtown, Hummelstown, York, Annville or Harrisburg, PA.


Schedule an appointment call : 717.832.5993

Schedule an appointment CALL : 717.832.5993

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