New Patient Intake Form

 

Weight Loss Addiction

Addictions:

  •  Food

  • Work

  • Tobacco

  • Drugs

Anxiety

Anxiety:

  • Phobias

  • Insomnia

  • Panic Attacks

  • ADD & ADHD

  • OCD

  • PTSD

 Pain points

 Pain:

  • Neck & Back Pain

  • Foot Pain

  • Knee Pain

  • Headaches

  • Nausea