Additional Consult

First Name

Last Name

Date of Birth

Age

What is your health concern?

When did it start?

What makes it better, worse?

Have you had it before?

Any health or lifestyle changes in anything prior to this?

Anything going on that I should know about?

Are you still on the herbal formulas that were recommended? And are you still experiencing your previous health conditions?

Disclosure and waiver- for your safety and mine. This consultation is not meant to be a substitute for any physical or mental healthcare you require. Consult with your primary care physician before undergoing any health or lifestyle changes. Katharine Stewart is here to educate, guide and support you on your health journey as you take responsibility for your body and your health. She is not a primary health physician nor is she dispensing medical advice. By accepting here you acknowledge your personal responsibility and release Katharine Stewart from any and all liability.

Thank you so much for taking the time to fill this out as thoroughly as you can!

I look forward to helping you feel better!

KateStewart

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