Forms for your visit with Denise Temple, Microscopist, Nutrition Coach & WholeLife Coach.  Please complete and bring to your appointment.

Philomena E. Marcus, CFNP     & 

​Patricia A. Loflin CFNP

Whole Life Coaching / Nutrition /

Live Blood Analysis / Dry Blood Analysis Form


 Forms for your visit with: 

 Philomena E. Marcus, CFNP


 Patricia A. Loflin, CFNP

 Please complete and bring to your appointment.

Patient Resources

New ​Patient Forms 

Call 505.750.0574

​   What type of appointment are you scheduled for?   

Revitalized Natural Health Center, L.L.C.

Cannabis Applications

Denise A. Temple, CHC, CH

Lyme Patient Form

Cannabis application please follow the link:

And complete your application details before your appointment. Please be certain to read the information and notice the items that you must provide at the appointment with your application. The completion of these details prior to your appointment will save you time and money.

Thank you!

This form is to be printed and completed for your appointment IF you have been diagnosed with Lyme.