Naturopathic intake form Disclaimer: The views, opinions, suggestions, and information contained in the consultation session or intake form do not represent the views of Plum Market or any of its team members 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out your personal information in the 'PATIENT INFORMATION' section. Include your full name, date of birth, gender, and contact details.
  3. In the 'MEDICAL HISTORY' section, list your health goals in order of importance. Be sure to provide details about any concerns and their duration.
  4. Next, document any current medications or supplements you are taking in the 'MEDICATIONS/ SUPPLEMENTS/ DRUGS' section. Include dosage and frequency for clarity.
  5. Proceed to the 'ALLERGIES, SENSITIVITIES, EXPOSURES' section to note any known allergies or sensitivities.
  6. Fill out the 'FAMILY HISTORY' section by indicating any relevant conditions affecting immediate family members.
  7. Complete the 'DIET & DIGESTION' and 'LIFESTYLE' sections with information about your diet, exercise habits, and overall lifestyle.

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