Health History Form

The better our communication, the more momentum we create toward solutions.

  • Tell your story! The more detail, the better.
  • Consider your health over your entire lifetime.

Submit 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.
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