Mass Functional Medicine

Mass Functional MedicineMass Functional MedicineMass Functional Medicine

Mass Functional Medicine

Mass Functional MedicineMass Functional MedicineMass Functional Medicine
  • Home
  • Inquiries
  • Services
  • Rates
  • Contact Us
  • FAQ
  • Resources
  • More
    • Home
    • Inquiries
    • Services
    • Rates
    • Contact Us
    • FAQ
    • Resources
  • Home
  • Inquiries
  • Services
  • Rates
  • Contact Us
  • FAQ
  • Resources

New Patient Inquiry Packet

All new patients must complete and return the new patient questionnaire by faxing to (845) 623-0049 or uploading directly to your MFM new patient record. Please download the Mass Practice Philosophy and two Patient Guides.  Only patient inquiries that are ready to schedule will have a patient record created. We will accept new patient questionnaires for brief review and limited courtesy feedback from Dr. Mass. Click on the "Download" button and look for the arrow pointing down at the bottom of your screen. 

MFM Lyme Disease Patient Guide (pdf)Download
MFM Lyme Disease Screening questionnaire - updated Aug 2022 (pdf)Download
Neuropsychiatric Manifestations of Lyme disease in Children (pdf)Download
MFM Practice Philosophy (pdf)Download

How to work with us

This is a checklist of how to get the most out of your medical care with us before your first consultation and in between appointments. 

Click on the "Download" button and look for the arrow pointing down at the bottom of your screen. The "Medication and Supplement Schedule" - in b&w or color - helps our patients with consistency on the treatment protocol and four-week  tracking until the follow-up visit. 

MFM How to Work with Our Practice (pdf)Download
BW Patient Medical and Supplement Schedule (pdf)Download
COLOR Patient Medical and Supplement Schedule (pdf)Download

Cerbo Patient portal

Log In

INS Medical EXAM FAQ & I-693 Form

Dr. Mass is a U.S. Civil Surgeon and offers the medical examination and completion of the I-693 form. 

Click on the "Download" button and look for the arrow pointing down at the bottom of your screen. 

I-693 Medical Exam Instructions Updated Oct 2021 (pdf)Download
BLANK I-693 medical exam form Updated 2021 Oct 01 (pdf)Download

HIPPA Authorization release form

For our existing patients, if you are requesting Dr. Mass to confirm or verify health information. We will accept requests for consideration after we receive this completed form. Patients may upload the completed form to their patient portal or by fax (845) 623-0047

Click on the "Download" button and look for the arrow pointing down at the bottom of your screen. 

MFM HIPAA Privacy Authorization Form (pdf)Download

Pharmacy resources

Fullscript

www.fullscript.com


 Phone: (866) 807 - 3828


Monday -Thursday: 9:00 am – 9:00 pm EST

Friday:     9:00 am – 8:00 pm EST

Saturday: 9:00 am – 5:00 pm EST

Sunday:   Closed

Woodland Essence

www. woodlandessence.com


Phone: (315) 845 - 1515


Mon, Tue, Wed & Thu:  9:30am - 3:00pm  EST

Biopure

www.biopureus.com


Phone: (425) 462 - 8414

LYME GRANTS

Please note the following:

  • Patients that demonstrate a true financial need are encouraged to apply
  • With some organizations, a letter is required from a Lyme literate or ILADS M.D. This means a patient would have to complete a comprehensive evaluation, in order to request this letter to include with your application
  • Each grant has its own deadline posted to the website
  • Each website has the most current information
  • In most cases the application process must be completed through their website
  • Please read through each website carefully and create a checklist of application requirements
  • Dr. Mass and Mass Functional Medicine staff cannot help the patient with the application process
  • Please plan ahead and allow for 24-36 hours for MFM to process your letter request for the grant application

Life for Lyme

  • Resource for general education and support
  • Website: https://www.chaiforlyme.org/

Ride Out Lyme

  • Learn more and apply directly on their website: https://www.rideoutlyme.org/apply-for-grant
  • Visit  their website for the next grand deadline
  • Applicant is at least 26 y.o. and older
  • Applicant must be diagnosed with Lyme
  • Applicant must be an active patient of a US-based Lyme-literate MD
  • Must be a USA resident

LymeLight Foundation

  • Learn more and apply directly on their website: https://lymelightfoundation.org/grants/
  • Visit  their website for the next grand deadline
  • Anyone diagnosed with Lyme disease through age 25 and can demonstrate a qualified financial need
  • Applicant must be an active patient of a US-based Lyme-literate MD, ND, DO, PA-C, or NP. NDs must have graduated from a CNME accredited institution. All practitioners must have prescribing rights in their state of practice
  • Must be a USA resident

Lyme Disease Association, Grant for Children - LymeAid 4 Kids

  • Website: https://lymediseaseassociation.org/category/grants/lymeaid-4-kids/
  • Application information: https://lymediseaseassociation.org/wp-content/uploads/2010/01/2016_LymeAid_4_Kids_Packet_FINAL.pdf
  • Visit the website to confirm application information is current
  • It is a program designed to get those processes started for those under 21 years old
  • It can provide up to $1,000 toward diagnosis and/or treatment for Lyme & other tick-borne diseases
  • It is available through any treating physician nationwide


Kiwanis NY

  • For NY State Residents only 
  • New York State Lyme Grant for children up to 17 years old
  • Visit their website for more information:  https://www.kiwanis-ny.org/lyme/

Lyme Treatment Foundation

  • Visit their website to apply directly: https://lymetreatmentfoundation.org/united-states-application
  • Citizens of Canada, the UK (England, Ireland, Scotland, Wales), Germany and the United States are eligible to apply
  • All ages
  • Applicant must be diagnosed with a tick-borne illness
  • Applicant must demonstrate a true financial need


Copyright © 2025 Mass Functional Medicine - All Rights Reserved.


This website uses cookies.

We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.

Accept