Medications & Supplements

 

Since many medications and their side effects impact our body and our body's metabolism and size, indicating your medical condition(s) and the medications/supplements you take is very useful in our work together. Please be thorough when completing this form. It's also always helpful if you indicate the condition or situation for which you're taking the medication/supplement. Getting a sense of the medications/supplements you take, is another important way to have a clearer understanding about you and your overall health issues.

I greatly appreciate your time and effort filling in the information below. If you have any questions or concerns, please let Susan know. Thank you!

Name *
Name
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Best Address
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Best Telephone
D.O.B
D.O.B