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Diane Culik MD
Virtual Holistic Medicine
Simple Steps to Better Health
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New Patients Must Print and Complete These Forms
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(Please Print the Demographic, Telemedicine Consent, and the New Patient History Form and Medical Release forms and Complete)
Then FAX to 888-480-3870 or
Please Complete either of These Below if:
1. You Have Medicare
2. You Need more space for Supplements
Learn More From Diane Culik MD
Check out Dr. Culik's online books on Amazon including information on:
Natural Thyroid, Adrenal Health, Bio-Identical Hormones, Weight Loss,
Acid Reflux, How to Live to 100, Gut and Gum Health and More.