The Healing Alternative
Nutrition History

Nutrition Medical History Form

Please download and print the form, complete it legibly, and bring it with you to your first appointment.
Don’t forget to include a list of all current medications,  nutritional and herbal supplements.

Download form here

Note:  This is a PDF file that requires Adobe Reader to open.

If you are not able to download or print the form, please come to your first appointment twenty minutes early in order to complete a form prior to your appointment.