Please list past medical conditions and hospitalizations
Please list medical conditions in the family including: siblings, parents, and grandparents.
Please list all allergies past and present
List all medications and supplements (if not listed above). Please include dosages if possible, and when you started taking.
Please list any other symptoms or health concerns not listed above that you have currently experienced whether they seem related or not to your present chief health concern(s).
Please select usual appearance
Usual appearance of urine
Do you get colds, runny noses, and flus easily?
Do you get frequent headaches
Description of menstrual flow (color, volume, etc)
Are your cycles regular?
My typical times for breakfast, lunch, and dinner are?
Include snack times
Physical Activity & Exercise
How many days a week are you doing structured physical activity?
Please share with us what types of exercise activities you are currently engaged in
Please list any activities you would like to explore and also activities you absolutely dislike doing.
List if any
When do you typically go to bed and when do you usually wake up?
Please indicate any other comments you feel are necessary for us when considering your case
Thank you! It is our privilege to partner with you on your health journey.