Mailing address
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Full street address and town.
If you would like us to come to you, what is the address where we should come to provide our services?
Full street address, and town. Please include any extra details that will help us locate you.
Why are you making an appointment with us?
In your own words, tell us why you are interested in receiving our services
Do you have any existing health issues?
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We need a full picture of your current health. Please describe any health issues you are currently dealing with.
What medications, drugs, and supplements are you currently taking?
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Anything that you are regularly or semi-regularly taking, including prescription, over-the-counter, recreational, vitamins, and other supplements. It is important that you disclose everything so we can provide you with the best treatment possible.