Complete Lifestyle Diary Evaluation

Congratulations on taking a big step towards improving your health by allowing me to evaluate your Lifestyle Diary…I’m truly honored and look forward to working with you!

Below you’ll find a complete Health History Questionnaire and a Waiver…before we proceed you’ll need to complete the forms. The info you provide will actually assist my evaluation in that you’ll most likely be revealing both genetic and epigenetic predispositions towards certain conditions.  But PLEASE DON’T BE PUT OFF by some of the personal questions! If you feel uncomfortable answering anything, it’s your prerogative to leave it blank…I’m sure you understand it’s incumbent upon me to at least ASK all questions related to your overall holistic health & wellbeing (whether or not you choose to ANSWER the questions is totally up to you!)

And note that if you have the most recent version of Adobe Acrobat Reader (software) you can simply add text to the .pdf's! Or if you prefer a more traditional process you can print out the .pdf’s, fill them in by hand, scan them, and email them back to me (I've even had folks take pix of the filled in sheets with their phone then email them from their gallery...whatever works for you is fine with me!)

Cost: $55

Health History QuestionnaireWaiver of Liability

Feel Free to Reach Out

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