Complimentary Patient Prescreening

Technology has become such a vital component to the medical field

If you think you might have food sensitivities, are not currently working with a healthcare provider that offers LEAP, and are interested in working directly with Oxford, please fill in the information in the Prescreening form below. This will start the process of determining the likelihood that food sensitivities are playing a role in your health problems.

Note: If you are currently working with a LEAP provider, please DO NOT complete the Prescreening form.

SCALE OF SYMPTOMS SUFFERED DURING THE LAST SIX (6) MONTHS
Select option 0 If You Do Not Suffer From This AT ALL
Select option 1 If You Suffer Occasionally (less than twice a week) and It Is Not Severe
Select option 2 If You Suffer Frequently (2 or more times per week) and It Is Not Severe
Select option 3 If You Suffer Occasionally (less than twice a week) and When You Do It Is Severe
Select option 4 If You Suffer Frequently (2 or more times per week) and When You Do It Is Severe

CONSTITUTIONAL SYMPTOMS

LUNGS

EMOTIONAL/MENTAL SYMPTOMS

EYES

GENITOURINARY

HEAD/EARS

MUSCULOSKELETAL

SKIN

CARDIOVASCULAR

NASAL/SINUS

DIGESTIVE

MOUTH/THROAT

WEIGHT MANAGEMENT