Health History Form

The more information we work with, the more likely we are to uncover issues and find solutions.

  1. Tell your story! The more detail, the better.
  2. Consider your health over your entire lifetime.
  3. You can email laboratory test results at info@travisburch.com

Tell Me About Your Health History

EXAMPLE: "I was diagnosed with asthma at age 11..."
EXAMPLE: "I've been having trouble falling asleep lately..."
EXAMPLE: "I've been limiting eggs for the last week.."
EXAMPLE: "My digestion is improving, but I feel like I'm not as regular as I should be..."
EXAMPLE: "My sleep seems to have changed the last week or so..."
EXAMPLE: "I've been trying the B-Complex for 3 weeks now, and it seems to be..."
EXAMPLE: "No change here, but I'm wondering if I should buy an air purifier..."
EXAMPLE: "I've been prescribed __________ for the last two years..."
EXAMPLE: "I developed an egg allergy 2 years ago..."
This is how we'll communicate during our consultation.