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  INTAKE FORM  

INTAKE FORM

The intake questionnaire below is a standard wellness client intake form used to get a better picture of your health history. These questions will provide for more effective use of your scheduled consultation time and assist us to formulate a customized plan. Please read my disclaimer before filling out this intake form, you will be required to acknowledge you agree to terms & conditions.

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Disclaimer: All information, content, and material is copyrighted and for educational purposes only. Information and view points are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Always consult your physician first before starting any new diet, exercise, supplement, or lifestyle change.  These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

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