Forms To Complete Prior to Your Office Visit


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5445 La Sierra Drive  
Suite 102  
Dallas,  TX  75231  
drstephenrodrigues@msn.com  

 



Forms To Complete Prior to Your Office Visit

Click on the links below to view and print the following forms.

Patient Information Form

Health History Review - Comprehensive

 http://superpageshosting.com/drstephenrodriguescom/nss-folder/folder/Dr_Stephen_Rodrigues_ONLINE_2008_Financial_Policy.pdf

 

  Wellness Program

Stephen S. Rodrigues, MD

General Medicine, Medical Acupuncture and Myofascial Pain Therapy

5445 La Sierra Drive, Suite 102, Dallas, Texas

214-572-0333

 

Our Goals are to:

o       Treat your pain and get you off pain medications.

o       Promote restorative sleep.

o       Stabilize your emotional variability.

o       Restore your muscles and tissues to their original health.

For the mind and spirit:

·        Manage stress by refocusing your energies and keeping things simple.  You can best do ONE thing at a time.

·        Keep a positive attitude by practicing forgiveness. Let go of anger, resentments and grudges. Don’t let folks hook you into their drama. Avoid unhealthy people and programs. Do not participate in gossip.

·        Say NO (politely) to thing that will put your wellness program at risk.

·        Also prayer, meditation, aromatherapy, soothing music, reading, sewing, fishing, leisure walks and needlework are great examples. Read The Four Agreements: A Practical Guide to Personal Freedom (A Toltec Wisdom Book) (Paperback) by Don Miguel Ruiz.

·        Laugh, even at yourself.  Rent and watch your favorite funny movie. 

·        Drive the speed limit! You’ll get to your destination in about the same amount of time anyway.  People might ride your bumper and curse at you…Tune them out and keep your cool.

For the body:

·        Get regular massages. Use acupressure techniques, biofeedback, magnets, stones, and electro-stimulators. See a Chiropractor to get or keep the benefits of correct alignment.

·        Start a simple aerobic exercise program, i.e. walking, house chores, gardening, using hand weights, or doing floor exercises. 

·        Take time every day for yourself by relaxing by Breathing, Eye Exercises, Tai Chi and/or Yoga. Stretch all of the major joint areas.

Nutrition:

·        Eat sensibly to attain and maintain a reasonable weight. Choose foods that are as natural as possible i.e. whole grains, new grains such as amaranth, beans, peas, lentils, flax seed, nuts, fruits (Lemons), vegetables and lean meats.

·        Avoid raw sugars/High starchy foods. Sweet drinks/sodas. Refined starches such as white breads, pastas, bagels, corn oils, and fat-free snacks. Caffeine >2 cups/day and Alcohol >2 oz /day. Tobacco products.

Herbals and Supplements:

·        Take an A-Z type Multivitamin any brand. Take an extra B-Complex multivitamin, extra (to a total of) Vitamin D 2000 IU/day, Selenium 200 mcg/d, Zinc 50 mg/d and Copper 5 mg/d.

·        Riboflavin 100 mg/day (for migraines), Lithium Orotate 64.4 mg/day (for stress ask the doctor).

·        Magnesium Glycinate 400 mg/day. Epson’s Salts baths (magnesium through the skin) in a hot/warm relaxing, 2 cups per tub for 10-15 minutes.


Sitemap

Stephen S. Rodrigues, MD
5445 La Sierra Drive, Suite #102
Dallas, Texas 75231
Phone: 214.572.0333
Fax: 214.572.0328



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