Initial Wellness Consultation

  • Initial Wellness Consultation

  • SECTION 1 — CLIENT INFORMATION

    Please complete the following information before your wellness consultation.
  • Date of Birth
     - -
  • Format: (000) 000-0000.

  • SECTION 2 — WELLNESS OVERVIEW

    Please share more about your current wellness concerns, symptoms, and goals
  • How would you describe your current energy levels?
  • Which wellness practices do you currently use for stress management?

  • Section 4- Health History

    Please share relevant history and current wellness support information.
  • Have you had recent bloodwork or lab testing completed within the last 12 months?
  • Have you previously worked with a holistic practitioner or wellness coach?
  • Do any of the following run in your family?
  • Are you currently pregnant or breastfeeding?

  • SECTION 5 — FUNCTIONAL WELLNESS TESTING

    Functional wellness testing may help uncover underlying imbalances related to digestion, hormones, inflammation, stress, nutrient status, detoxification pathways, and overall wellness patterns.
  • Are you interested in functional wellness testing support?*
  • Which areas are you most interested in exploring further?
  • Have you completed any functional wellness labs previously?

  • Educational Notice

    Functional wellness testing support provided through Queen Bey Health is educational in nature and intended to support wellness awareness, lifestyle education, and personalized wellness strategy discussions. These services are not intended to diagnose, treat, cure, or prevent disease.

     

  • SECTION 6 — LIFESTYLE + WELLNESS HABITS

    Daily habits, stress levels, nourishment, movement, and environmental exposures can all influence overall wellness and how the body functions.
  • How often do you consume caffeine?
  • How often do you consume alcohol?
  • Which forms of movement or exercise do you currently practice?
  • Which wellness practices do you currently use for stress support or nervous system regulation?
  • Are you regularly exposed to any of the following?

  • SECTION 7 — CONSENT + WELLNESS DISCLAIMER

    Please carefully review the following information before submitting your wellness consultation intake form.

  • WELLNESS DISCLAIMER

     

    Queen Bey Health provides wellness education, holistic wellness support, lifestyle guidance, and wellness-centered consultation services intended to support overall well-being.

    Services, educational materials, herbal wellness discussions, and functional wellness testing support are not intended to diagnose, treat, cure, or prevent disease and are not a substitute for medical advice, diagnosis, or treatment from a licensed healthcare provider.

    Any functional wellness testing discussed through Queen Bey Health is provided for educational and wellness awareness purposes only and should not be interpreted as medical diagnosis or treatment.

    Clients are encouraged to consult with their licensed healthcare provider regarding medical concerns, medications, diagnoses, or treatment decisions.

    By participating in wellness services through Queen Bey Health, you acknowledge that you are voluntarily engaging in wellness education and holistic wellness support.

  • Date Signed*
     - -
  • Should be Empty: