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Treatment Forms and Map

You will find on this page the forms for providing a description of your medical history, important information for creating effective treatments for your condition, and an area map of our office.  Please download and fill out these forms and bring them to your first appointment.  If you cannot read these forms, please contact us at 301.228.3764 with your fax number and we will send them to you.

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The first form is for you to provide your medical history and other factors which are influencing your health

Click here for Form #1 .pdf version              

Click here for Form #1 Word version

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The second form is for people who have Lyme disease (or Lyme and fibromyalgia).

Click here to download and fill out the Lyme Symptoms List .pdf version

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The third form is for people who have fibromyalgia.

Click here to download and fill out the Fibromyalgia Symptoms List .pdf version

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Once you begin treatment, we will give you a treatment receipt at the end of each session that you will submit to your insurance provider to receive reimbursement. 

The fourth form is a map of the area around the Frederick office.
Click here for a map of the Two Frogs Healing Center in Frederick.

Parking is available in the lot behind the center. The entrance is on the left side of Bentz Street. You will see a big elm tree in the center of the lot. Park at any of the red and white signs.

Please use a service like www.mapquest.com to get driving directions or call us at 301.228.3764.

Now you know about the forms needed for treatment, please contact us if you have any questions about filling out these forms at 301.228.3764 or at twofrogshealingcenter @gmail.com. 

Click here to return to Contact Us.


 


Two Frogs Healing Center
170 West Patrick Street
Frederick, MD 21701
301.228.3764 (301.ACU.FROG)

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Many thanks to Professor Charles Chu, Ph. D and his supportive family for permission to use his brush painting frogs in our logo.  Click here to see his website.