Medical Intake Formadmin2023-05-01T05:33:34+00:00 Please note that filling out the form below is required to proceed. We kindly ask that you provide accurate and complete information to ensure a smooth and efficient processing of your request. Detailed Medical Intake Form Your email Enter you name Digestive Troubles & Liver Inflammation IBS/IBDBloatingGas/FlatulenceAcidity/Acid Reflux/GERDLactose IntoleranceFood Sensitivities /AllergiesH-Pylori other infectionsGall Stones & Kidney StonesC-leveled EnzymesFatty Liver Hormonal Imbalances Insulin - Insulin ResistanceThyroid (Hyper & Hypo)Estrogen - Estrogen Dominance/PCOSCortisol - Stress/Anxiety DepressionMenopause/ Menstruation ProblemsFibroids Autoimmune Conditions Rheumatoid ArthritisHashimoto's ThyroiditisLUPUSDiabetesAcneAsthmaPsoriasisRosaceaEczemaBronchitisSleep ApneaSinusitis TinnitusOther Bone/Joint/Spine OsteoporosisArthiritsCervical SpondylitisBackpainStiffnessKnee PainAise Herniation/Prolapse Slip Disc Metabolic Syndrome High Blood Pressure HypertensionHigh cholesterol/TriglyceridesPot Belly/Belly FatStubborn Weight GainIncreased WaistilineHigh Uric Acid Life Changing Concerns CancerParkinsonAlzheimerHeart Disease Adrenal Fatigue Disturbed sleepHigh StressLow Energy LevelsConstant Brain Fog/Focus IssuesMemory Loss Others Weight-Gain/Inch-LossDull PigmentationDry Flaky SkinAging SkinHairfall/HairlossBrittle NailsBelly Fat/ Thigh/ Arm Fat Are you on any sort of medication?
