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Authentic Wellness Client Intake Questionaire

Thank you for your interest in my holistic nutrition and wellness services. My patient intake is a comprehensive questionnaire designed to provide insight into all areas of your health. The more detail you provide, the better the results of your consultation will be!

We take your privacy seriously, none of the details you provide will ever be shared with a third-party. If you are uncomfortable with any of these questions we can complete the questionnaire in-person, during your first consultation.