Let's Help You Get Well Again.

Readiness Assessment and Health Goals

Are you willing to pay for health care out of pocket?

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Rate on a scale of 5 (very willing) to 1 (not willing): In order to improve your health, how willing are you to:

Significantly modify your diet

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Take several nutritional supplements each day

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Keep a record of everything you eat each day Modify your lifestyle (e.g., work demands, sleep habits)

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Practice a relaxation technique

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Engage in regular exercise

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How confident are you of your ability to organize and follow through on the above health-related activities?

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If you are not confident of your ability, what aspects of yourself
or your life lead you to question your capacity to follow through?

At the present time, how supportive do you think the people in your household will be to your implementing the above changes?

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Rate on a scale of 5 (very frequent contact) to 1 (very infrequent contact):

How much ongoing support (e.g., telephone consults, email correspondence) from our professional staff would be helpful to you as you implement your personal health program?

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Health Goals

What do you hope to achieve in your visit with us? (required)

When was the last time you felt well?

Did something trigger your change in health?

What makes you feel better?

What makes you feel worse?

How does your condition affect you?

What do you think is happening and why?

What do you feel needs to happen for you to get better?

Your Name (required)

Email (required)
Confirm Email (required)

How did you hear about us?