I5 Min Wellness Consult.

15 Minute Free Consultation

Consultation Form Instructions:

We are a paperless practice; our website, email and virtual conferencing platform are secure for conferencing, payment and the transmission of your records and information. If you have questions please don't hesitate to give us a call.

All clients must complete the following forms and return them prior to their scheduled appointment time.

Schedule your appointment by going to Schedule & Payment.

We do hope you consider our programs to find your own ANSWERS, RESULTS & HOPE.

schedule your 15 min. free consultation

My Story

Instructions:

Your Story

The purpose of this form is for you to give a little more background information about yourself, condition, etc.

In your own words please tell me "your story". Take as much space as you need. Please include the follow:

When did your health challenges begin and how long before you sought help?
Did you get a diagnosis and medication? If so, what was the diagnosis, how often have your medications and dosages been changed?

FYI: It's most helpful if the information is given in a timeline formate.

15 Minute Free Consultation Forms

15 Minute Free Consultation

Consultation Form Instructions:

My Story

Instructions:

Disclaimer of Liability