Intake Form

“It’s far more important to know what person the disease has than what disease the person has.”
— Hippocrates

Your intake form is one of the most important aspects of your program - it's how I learn about you. Your past is a story about how you came to be where you are today. The information I learn from your intake form will allow me to tailor my clinical skills to your individual health needs, so that together we can create a plan for a healthy future.

This intake form is very comprehensive. Some people find it helpful to set a timer for 10-15 minutes, and work on filling out this form in small increments each day until it's complete. Please take your time, and make sure to follow the instructions below carefully:

This form must be downloaded, saved, and filled out on your computer's desktop or printed and filled out manually.  DO NOT FILL IT OUT IN YOUR BROWSER! If you are not sure how to answer, leave a question mark next to the question, and we can discuss it in our consultation if necessary.

Once the form is completed, please send it to jason@biologicalhealthandnutrition.com. You may then schedule your 1 hour Health Evaluation with me. Please allow me 48 hours to go over your intake form before our scheduled appointment date. Please note, we cannot meet until I have the intake form filled out and returned to me, so do not schedule a health evaluation until this step is completed.

Please click on the button below to download the intake form. DO NOT FILL THIS FORM OUT IN YOUR BROWSER! DOWNLOAD IT ONTO YOUR COMPUTER'S DESKTOP AND FILL IT OUT THERE.! REMEMBER TO "SAVE" OFTEN!