Duquette Functional Medicine Logo

806 E Washington St., Bloomington, Illinois 61701

Patient Forms

Complete our New Patient Intake form and Dr. Duquette will review your case and answer any questions you may have. If you are a candidate for Comprehensive, One on One care, we will then go over our New Patient Intake process and in-person scheduling options.

To get started on your New Patient Intake Form, click the link below.

Be sure to have enough time, about 15 minutes, to fill out the intake form.

Each time you access the intake form the site will ask for a one-time passcode that you will receive in a separate email message at that time.

Feel Free to contact us with any questions or technical issues.

Intake Form Link