PRE-CONSULTATION QUESTIONNAIRE

PRE-CONSULTATION QUESTIONNAIRE
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Today's Date

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It was nice talking to you today and I look forward to our consultation! In order to prepare for the consultation, please fill out this form on-line. Write up your complete case history in a chronological order. If your symptoms began as a child, please note that and how old you were.
If not included above, what happened, what treatment did you receive, what worked and what didn't work.
List medications and nutritional supplements you are currently on.
How are you doing now?
What do you hope to accomplish in our consultation together?
What are the things you would like to be doing that you can't do right now ?
What things would you be doing if you didn't have this current condition?
Attach any lab work that you have here, or email it to drlaaravan@gmail.com

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Please download, fill out and return the following attached symptom questionnaires.

To fill out form: Right click and 'save link as' to save the forms to your computer, then open in PDF reader like Adobe Acrobat Reader. Once you've filled out the form in Reader, save as a new file on your computer and attach below.

Questionnaire 1

Questionnaire 2
Upload Filled In Questionnaire 1 Here

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Upload Filled In Questionnaire 2 Here

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Please have this information in 24 hours prior to your consultation appointment. If you are unable to upload any of the forms please email them to drlaaravan@gmail.com

Allow up to an hour for your consultation.

Thank you for your interest in improving your health and I look forward to speaking with you soon.

If you are not able to email, my fax number is 425-974-1543

For questions, my cell is 425-785-5504

Dr. Laara Van Bryce
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