Vitalized Performance Group

You may print the patient forms ahead of time. You can fill them out before you come for your appointment or come in 15 minutes prior to your appointment and fill them out in our office.

We appreciate you filling out the entire form even if you do not foresee yourself having some of the services offered. The more information we have, the better we can find and treat the root cause of the health issue.  

Please bring in any lab work you had done within the last 6 months.  

Patient Forms


(print, fill out and  bring it to your first appointment, to save time)

For first time Colonics please read the information and do the follow:

open link

Fax: 860-430-2843 

Email: [email protected]  [email protected] is a HIPAA COMPLIANT 3RD PARTY ENCRYPTED EMAIL: PLEASE USE THIS EMAIL FOR ALL IMPORTANT AND CONFIDENTIAL EMAILS. ALL PROVIDERS HAVE ACCESS TO THIS EMAIL. We understand that many households use shared e-mail addresses. You give us permission to send emails where others can potentially access the information. With today’s advances in technology and the busy lifestyles that people lead, email is often preferred over other forms of communication when it comes to confirming appointments or sending lab test results. However, patients/clients should be aware that even despite extensive efforts on the part of the healthcare provider to protect sensitive information, no email is 100% safe

Snail mail or drop in our mailbox: 

212 New London Turnpike, Suite D Glastonbury, CT 06033

Please bring in your photo ID at your appointment . 

Colon Hydrotherapy: For first time clients, the first step is to print the patient intake form. You can get it back to us by using the methods described here. Our naturopathic doctor will review your intake form and make sure receiving colonics is safe for you.  You might expect a call to go over your information. You will then receive a call or email from our office to find out if you are approved.  We can then book your appointment. 

This is an annual requirement.