p | Holistic Health

The easiest and most natural way to have a healthy, balanced life.

Holistic Health

and Wellness

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Our mind and body are one. Stress can create muscle tension, digestion influences our mental state, relationships contribute to our evolution.

When we give our bodies proper nourishment, self-care, and a healthy environment, our mind becomes more peaceful and that transformation starts to shape our outer world and life.

Holistic health and wellness provides the therapies that support our mind, body, and natural process of healing.

When we return to the natural way of being, staying healthy becomes easy.

Intake Form

First name

Last name

Date of birth

Phone

Email

What is your primary reason for this session and/or your health?

Physical Body and Mental Health

Your Body

Anything that wasn't in selection or Anything you would like to add.

Energy

Mostly low

Stable

Mostly high

Fluctuates either high or low

If you are in pain, how long have you been in pain for and what is the severity?

Do you have any diagnosed medical conditions, injuries, or surgeries?

Anything that wasn't in selection or Anything you would like to add.

Nutrition

.

Healing the body with food and supplementation

How to cook and plan weekly diet

Wellness program: Cleanse and Rejuvenate

Are you currently taking any medications or supplements?

Anything that wasn't in selection or Anything you would like to add.

Exercise

Yoga Restorative

Qi-gong and Tai chi

Strength training and Postural Alignment

Mental Health

Are you interested in Nervous system regulation, help for P.T.S.D, or would like to learn more about meditation

How is your sleep quality

Anything else you would like to share in regards to your situation

What are you hoping to experience or achieve through our work together?

Visit Preference

Drop-In

Monthly visit - membership rewards

Wellness Program - Multi-session personalized plan

Final Thoughts. Any questions or concerns before our first appointment?

CONSENT STATEMENT

"I confirm that the information provided is accurate and I consent to receiving holistic health and wellness services from Human Nature. I understand these services are complementary in nature and do not replace conventional medical care."

I agree to the above statement

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