Wellness Evaluation

  • Read/Sign Intake Form/Disclaimer

  • Some Questions Will Ask You to Rate The Frequency & Severity of a Symptom on a Scale of 1-3

  • Enter "1" if a Symptom is Irregular or Mild​

  • Enter "2" if Frequent and/or Moderate

  • Enter "3" if Very Frequent and/or Disabling

  • "Leave it Blank" if a Symptom Does Not Apply to You

  • Fill Out The Questionnaire as Accurately & Honestly as Possible

  • Be Aware: The questionnaire may seem long, but this is absolutely necessary for me to be able to evaluate all of your bodily systems 

What You'll Receive
  • An email containing the 

      practitioner's findings based on the         answers you have provided in the             questionnaire


  •  A breakdown of which bodily systems may look to be out of balance and what might be causing this.


  •  A list of herbal/supplemental recommendations that may help the body address the possible imbalance/s itself

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