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Intake Questionnaire
I think it would help if you included an explanation of why this is important!
This questionnaire is to help you and I understand your health concerns. If you prefer not to answer a question, please leave it blank. You are not obligated to complete this form.
User keys to online intake form, that loads spreadsheet database, which will ultimately be accessible via owner-only web pages.
Please check the types of health care practitioners you have seen or are seeing.
Chiropractor
Naturopath
Counselor
Massage Therapist
Herbalist
Medical doctor
Homeopath
Occupational Therapist
Psychiatrist
Psychologist
Social Worker
Other
Check if you've had recent bloodwork done, and please bring a copy of the results with you to our visit.
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