Visitor Intake Information

Please provide a full description of any medical, emotional and even spiritual challenges you are facing or need to resolve.

You must fill out an intake questionnaire. You can copy the questions and use them in the last box to answer.

1)  Your Skype

2)  If you have a medical problem what is the problem, when it began, how is the situation now;
 
3)  Which treatments, conventional and alternative, that were taken up to this moment

4)  Which medicines and supplements are you taking now?

5)  Special Dietary Needs?

6)  How many times a minute do you normally breath? Take out a watch and count your breath for one minute. Try to breathe at your normal rate. Inhale and exhale together is one breath.

7)  What is your saliva and urine ph?

8)  What is your basel body temperature? (Basel body temperature is your temperature taken first thing in the morning before you get out of bed. This gives the lowest body temperature attained during rest.)