Please schedule an appointment before filling out the intake form. Name: * First Name Last Name Have you been here before? * First Time Over 8 months Less than 8 months Email: * Phone: * (###) ### #### List of Current Problems: * List of Resolved Problems: List of Doctor Prescribed Medication (and what they are for): Do not include supplements or anything recommended from this office. Only RX prescriptions. Are you on blood thinners (besides aspirin) * Yes No Clicking submit confirms the Client-Practitioner relationship. Adam Fleming HHP cannot diagnose, treat, or prevent diseases. He can only find imbalances in your body and provide herbs and therapies to correct them, which can typically fix the client's issues. Clients are responsible for their health, such as herbal remedies, therapies, and diets modifications. This office only tests and makes recommendations to balance the body, but clients must follow directions, reorder, and schedule follow-ups. Healing relies solely on client compliance. As a result, we do not accept smokers due to inability to balance their body. Thanks! I have read the above statement in full and agree to it completely: Yes No (Please cancel my appointment) Thank you!
