Intake Forms

Please have your intake forms completed and returned to me (Serina) a minimum of 3 days prior to our initial consultation. Feel free to Contact Me if you need help!

 
 

CCHQ (confidential client health questionnaire)

Please complete this questionnaire prior to our initial consultation.


Office Policies

This is a copy of our office policies for you to review and sign electronically prior to our Initial Consultation.


Informed Consent and disclaimer

Please fill out and electronically sign this Informed Consent and Disclaimer prior to our Initial Consultation.


Food Logs and Journal

Please complete 3 consecutive days of Journals prior to our Initial Consultation. Be as detailed as possible and note any symptoms you might experience throughout the day (sleepiness, gassiness, reflux, etc.).


Nutritional Assessment Questionnaire

Please use this link to access your personal Nutritional Assessment Questionnaire (NAQ/Nutri-Q).

Your personalized log-in information may be found within your Intake Form Check List (a To-Do list item) inside of your Client Portal (Basecamp).

If you do not yet have access to Basecamp, please Contact Me and I will get you set up.