4EVEREVOLVN

WE ARE 4EVEREVOLVN!! We are excited to help you on your path to improved well-being and a healthier, more balanced life. This intake form has been designed to understand your unique needs, preferences, and goals. By gathering this information, we can create a personalized and effective holistic health plan just for you!


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Full Name *
Email *
Phone Number *
Do you have any existing medical conditions? If yes, please list them.
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Are you allergic to any foods, environmental factors, or medications? If yes, please specify.
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How often do you exercise, and what types of activities do you engage in?
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On a scale of 1 to 10, how would you rate your stress levels? What are the main stressors in your life?
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Describe your typical daily meals and snacks
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Have you experienced anxiety, depression, or other mental health concerns in the past?
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What specific health goals would you like to achieve? (e.g., weight management, improved energy, reduced pain)
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If you are wanting to incorporate fitness into your journey, do you have or are you seeking a personal trainer? *
Is there any other relevant information you would like to share with us?
Would you be interested in incorporating herbs into your health regimen?
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