Northern Appalachia Clinic New Client Form

This form has been designed to help me get to know you better, so that we can make the best of our scheduled appointment time together and guide you effectively. I ask that you please complete it to the best of your ability. If there are sections that you feel uncomfortable writing about, and would rather discuss in person, either for ease of mind or out of practicality, I am happy to accommodate you. I invite you to make notes on your form and ask questions upon arrival to your appointment. For your safety, I do request transparency with diagnosed medical conditions and allergic reactions, as well as that medications, herbs, and supplements you are currently taking. Thank you!