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Forms

All patients must complete a New Patient Questionnaire, which provides Dr. Burkhart with the information necessary to understand your condition and how she can best help you.

Please download the forms below for information for your first visit.

*Please submit your health questionnaire via fax: (707) 927-5747 or mail: 1100 Lincoln Ave. Suite 200, Napa, CA 94558 at least one week ahead of you appointment date. You may also drop it by the office at any time. There is a locked drop box at the door.

 

*If we have not received your questionnaire prior to your appointment we will ask that you reschedule your appointment.

*If you are attempting to get an appointment sooner than is currently available, please send in your questionnaire as soon as possible. Priority for cancellation spots is given to patients with a completed questionnaire.

Due to health privacy rules Dr. Burkhart is unable to receive questionnaires via email.

New Patient Questionnaire
New Patient Checklist

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Testimonials

“Dr. Burkhart’s training as a physician, dietitian, and integrative practitioner is a unique and invaluable combination. Her kind and supportive demeanor, personal experience with celiac disease, and keen intelligence make her an excellent doctor, in particular for anyone with food intolerances and digestive issues. Dr. Burkhart has been an extraordinary ally of our celiac and gluten sensitivity community, volunteering her time to educate other physicians and dietitians throughout the Bay Area for years, serving on our nonprofit board, and sharing her knowledge with our members in support groups and events.”

Jennifer Iscol President
Celiac Community Foundation
of Northern California

4 months ago

Last camp post until next yr! If your child lives in Northern CA and has celiac disease or follows a strict gluten-free diet consider the camp for next year. It is life changing for these kids and is free of charge as we are all volunteer. Thus, children who might otherwise not be able to attend for financial reasons are given the opportunity of a lifetime. If you would like to support the camp you can do so by making a donation to Celiac Community Foundation of Northern California or The Taylor Family Foundation. The donations allow the camp to continue. Thank you for your support. ... See MoreSee Less