Naturopathic Path

Naturopathic PathIt’s rare for anyone to get to work toward their natural health goals with a committed trained professional. No one diet, lifestyle, herb or exercise program works for everyone, so I will work with you to find the correct modalities that best support your constitution and well-being. Together we will determine what changes are most appropriate for you, then incorporate gradual, lifelong modifications that will enable you to reach your current and future health goals.

The initial Naturopathic Phone/Skype Consult is a one hour appointment that includes a complete holistic analysis. This approach to wellness means that we will work together and assess the complete you, mind, body and spirit to find where possible imbalances may lie. All areas of your life are connected even though you may not realize it. For example, a stressful lifestyle can raise cortisol levels making it impossible to meet your weight loss goals. If one body system is out of balance it affects all the others. I practice a holistic approach to health and wellness, which means I look at how all areas of your life are integrated.

After reviewing your Naturopathic Analysis I will give you a detailed explanation of where imbalances may lie, as well as dietary guidelines, herbal suggestions, relaxation techniques, and exercise and lifestyle recommendations to restore health.

A two week follow-up appointment is included and ongoing support and guidance as you set goals and make sustainable changes for improving your health and happiness.

  • Increase energy so you can enjoy life to the fullest.
  • Improve digestion and eat for your true self.
  • Sleep better and wake up less drowsy.
  • Detoxify your mind, body and spirit.
  • Reverse signs of the aging process.
  • Reduce pain and discomfort.
  • Lose weight and feel great.
  • Improve mental clarity.
  • Achieve inner and outer beauty naturally.
  • Achieve your wellness and fitness goals today!

Initial Consultation, Wellness Recommendations and Two week follow-up appointment: $175

Weekly/Monthly Follow-up Consultations: $30.00 per half hour

Wise Wellness Combos

-Bio-Individual Detoxification Program (1 wk) & Naturopathic Evaluation/Program: $260

-Bio-Individual Detoxification Program (1 mo) & Naturopathic Evaluation/Program: $300

Naturopath Analysis Form

Your Name (required)

Your Email (required)

Date

Age

Birth Date

Address

Home Phone:

Work Phone:

Height:

Weight: 1 Year Ago: 5 Years Ago:

Occupation: Full Time Part Time 

Living Situation:
Alone Friends Partner/Spouse Parents Children Pets 

What are your major health concerns and intentions for your visit today?

Please list any other health care providers or consultants you are currently working with:

Please list any current health conditions diagnosed by a medical doctor:

When was your last physical exam?

Please list all herbs, vitamins, and dietary supplements you are currently taking, including dosage and frequency:

List all medications you are currently taking (including aspirin, antacids, etc.) indicating whether they are over the counter (OTC) or prescription, including dosage and frequency:

List all medications, herbs, foods, environmental factors, to which you have a known allergy:

DIETARY INFORMATION

Describe below your typical meals. Please be as specific as possible. For example, instead of “oil” note the type of oil, such as olive, corn, etc. Instead of “bread” list whether it is white or whole grain, etc. Instead of “vegetables,” list the type of vegetable, how it was prepared, whether canned, frozen, or fresh, etc. Please include the type and quantity of all beverages (two cups of orange juice, one cup of coffee, etc.).

Breakfast:

Morning snack(s):

Lunch:

Afternoon snack(s):

Dinner:

Daily water consumption (number of glasses/day):

Any recurring food cravings (such as salt, starch, sugar, chocolate, etc.)? Please list as many as applicable including time of day or month:

FAMILY HISTORY

Please describe any relevant or major health related issues (cancer, mental illness, diabetes, heart disease, etc.):

Mother:

Father

Sister(s)

Brother(s)

Maternal Grandmother:

Maternal Grandfather:

Paternal Grandmother:

Paternal Grandfather:

MEDICAL HISTORY

List all major health problems including any operations:

Year: Problem:

Year: Problem:

Year: Problem:

Year: Problem:

Year: Problem:

General Health

Cardiovascular Skin Muscles/Joints:
High blood pressure Boils Low blood pressure Bruises Pain in heart Dryness Poor circulation Itching Swelling Varicose veins Backache Broken bones Limited mobility Arthritis Bursitis Stroke/murmur Skin eruptions Weakness 

Respiratory Urinary/Kidney Gastro-Intestinal:
Chest pain Difficulty breathing Cough Tuberculosis Congestion Itchy ears/eyes Asthma Coughing up blood Excessive urination Water retention Burning urine Kidney stones Lower back pain Wheezing Circles under eyes Blood in urine Belching Colitis Constipation Abdominal pain Liver disorders Gallstones Ulcers Digestive troubles 

Eyes, Ears, Nose and Throat:
Ear aches Hay fever Sore throat Canker sores Eye pains Failing vision Sinus infections Sinus congestion Tonsils Hearing loss Nosebleeds Difficulty breathing 

General:
Fatigue Excessive thirst Difficulty sleeping Night sweats Loss of appetite Irritability Fever Always hungry Cold hands and feet 

Male Reproductive:
Burning/discharge Painful testicles Lumps/swelling of testicles Vasectomy 

Female Reproductive:
Age of First Period:
Irregular cycles Heavy bleeding Blood clots Vaginal discharge Vaginal itching Painful intercourse Vaginal dryness Breast pain Breast lumps Infertility Genital herpes Mood Swings PMS Pre-menopausal Menopause Pains/cramps Pelvic pain Anemia Hot flashes Not able to conceive 

Contraceptive/Pregnancy History:
Birth Control Pills Diaphragm Cervical Cap Rhythm-method Condoms Spermicides I.U.D. Mucous-method Fertility lens 

Please list each pregnancy you have had, including miscarriages:

CURRENT STATE OF EMOTIONS AND SPIRITUAL WELL-BEING

Please check all those that describe you:

Please list approximate dates and describe the nature of any traumatic experiences you have had in the past 7 years (divorce, surgery, end of a relationship, loss of job, change of residence, injury, death of a loved one, etc.):

Year
Event:

Year
Event:

Year
Event:

Year
Event:

Year
Event:

LIFESTYLE HABITS

Do you engage in regular physical activity?
Yes No 

If yes, for how many minutes? How often?

Do you smoke tobacco? Yes No 

If yes, how much? /day

Do you drink alcohol? Yes No 

If yes, how much?  How often?

Do you drink coffee and/or caffeinated beverages? Yes No 
If yes, how much?  How often?

How many hours of television do you watch in a week?

Do you use artificial sweeteners? Yes No 

Please use this space to add any other information about yourself that you think will be
helpful: