Naturally Well Inc.

Biofeedback and Wellness Services

NATURALLY WELL INTAKE FORM AND AGREEMENT

ABOUT THE INTAKE FORM
Thank you for your interest in working with Naturally Well. Every effort is made to meet your needs and support you in achieving optimal health. Prior to scheduling consultation, I will need the intake form and all labs/reports emailed for review. Please provide attachments and addendum's as needed to allow for thorough and complete descriptions and explanation of your situation.
Email all reports and forms to: Healwithchristine@gmail.com Phone: (949) 697-3152 Fax: (949) 363-7613
Depending upon my calendar and case load will determine scheduling of a consultation. When I have complex cases, this process can be delayed, but please understand that I will turn clients away if the matter is urgent, and you are unable to wait. I will not compromise service and quality in my practice
Reply and correspondence emails will be returned in 2-3 business days. Please keep emails to a minimum between appointments, and please be direct and state the issue in Subject of email. Emails formatted with questions are best, so I can respond directly to the questions. When the issue is more complex, we may need to schedule a short consult/call so I have the proper context to evaluate.
FEES AND SERVICE:

Initial Consultation $350 A review of intake, history, labs before we meet/consult, followed by phone consultation and email with plan of care.

Follow up Consultations $175 per clinical hour (50 minutes.)

Payment is due upon services rendered. Services are nonrefundable. 48 hour cancellation notice is required for a refund of charged services, or to avoid being charged. Credit cards and checks are accepted. .

DISCLAIMER:

Records and Health Journal: I highly recommend keeping a record of all labs and test reports in a home file. Whenever you have a test or lab done, please obtain a copy for your home file. In addition, I recommend keeping a health notebook or journal to chronicle and keep notes in to track symptoms, supplements, dietary changes, etc.

All services and information provided by Naturally Well Inc. are not intended to be a substitute for medical advice, diagnosis or treatment by your in-network health provider. Please discuss with your primary provider as needed. I am happy to collaborate and discuss with your primary provider on any issue that you provide consent for. Many are not familiar with Biotoxin illness or a Functional Medicine approach. Achieving the highest level of health naturally is my mission and I am dedicated to educating and empowering you to achieve the highest level of health through diet, lifestyle, and Biofeedback services.