Students are eligible for a 40% discount on consultations
Please write a history of the chief concern(s) including: when it started, current symptoms and treatments (including medications, supplements), what you hope to achieve through naturopathic care, and any other pertinent information you feel is necessary.
Please list any particular treatments you are currently doing to address your health concern.
- Eating more bran to address sluggish bowels
- garlic for cholesterol
- exercising to lose weight
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 select usual appearance
Usual appearance of urine
Do you get colds, runny noses, and flus easily?
Do you get frequent headaches
Menstruation (If applicable)
How long is your cycle?
Description of menstrual flow (color, volume, etc)
Are your cycles regular?
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
When do you typically go to bed and when do you usually wake up?
1 = no stress
10 = Extremely high stress
1 = no energy
10 = Highest level of energy
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.
To secure your spot, please proceed to the payment page at this link here.
Your partners in Health,
Pathways to Wholeness Lifestyle Medicine Center