Patient Info

For aesthetics and laser services patients we are happy to provide an initial complimentary skin assessment. To get started please call or contact our office, you may complete the new client forms found on the 1st visit page

Integrative Health Visit

Patient Forms

  • Rebalance Visit Intake Form
  • Wellness Visit Intake Form

We look forward to your visit and hope that you have a wonderful experience at our practice. We strive to deliver holistic, individualized, and compassionate care to help you look and feel your best.
In preparation for your first visit please download and fill out New Patient  Intake Forms. Feel free to use the weekly diet diary to write your food intake. Please bring them with you on your first visit.

  • Please allow approximately 2 hours for your first visit.
  • We will take an extensive medical history, provide detailed consultation, and a physical exam as part of your first visit
  • We might perform different tests (blood, saliva, urine) that are necessary to help us to evaluate your current condition. Testing might include nutritional profiles, hormonal levels, allergy testing, and genetic markers to name a few.
  • Bring a copy of your previous blood work, diagnostic results, and medical records from previous health care providers that you’ve visited. Provide a list of all the health care practitioners, therapists, and alternative practitioners that you are seeing, and describe the types of treatments you are receiving from them.
  • Make a list of all the medications, supplements, herbal remedies, and herbal teas that you are consuming with their respectful dosages and time taken during the day. Many supplements and herbal remedies can interact with prescription drugs; If possible, bring bottles of your medications and supplements with you; you may also photograph them with your mobile device and bring photos with you.  Explain why you are taking them, and report accurate dosages of your supplements and medications.
  • If you suspect that you might be experiencing hormonal imbalances and are not sure which symptoms might be important, feel free to fill out the hormonal imbalance questionnaires provided here, they will help you to put all your symptoms together and to get a clearer picture of your condition.
  • Make a list and describe your symptoms accurately, and stay focused on the most important details pertaining to your health care problem.  Bring a list of questions to ask your health care provider.
  • In several weeks you will have a follow-up visit where we will discuss all the treatment options available for your diagnosis, including alternative treatments.  You will also receive detailed information on the benefits and side effects of particular treatments, what to expect, and how long will it take to see results.

Do you have questions? Would like to schedule an appointment with the top Wellness & Holistic Doctor in Midtown NYC, Dr. Natalya Fazylova, please contact our office.

ReBalance of Radiance Aesthetics & Wellness

NYC Holistic Health & Wellness
635 Madison Ave #1400
New York, NY 10022

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