New Client Consultation Form

Please complete all sections to the best of your knowledge. Take your time. Kindly fill out every section as accurately as you can. Take your time—thorough answers help us care for you better.

Consent to contact

Please read carefully and sign.

HIPAA

Please sign

Follow-Up

This helps us understand the changes in your constitution since starting your remedy. Please keep a daily journal of your experiences, symptoms, and any changes after taking the medicine, and bring these notes to your follow-up appointment for discussion.