Herbalist intake form 2025

1. Click ‘Get Form’ to open the herbalist intake form in the editor.
2. Begin by filling out your personal information. Clearly print your name, address, telephone numbers, email, and occupation in the designated fields.
3. Provide details about your health history. List all healthcare providers you see regularly, including their names and types of services offered.
4. Complete the family medical history section by detailing any significant health issues within your family. This helps the herbalist understand potential hereditary conditions.
5. In the present health status section, answer questions regarding smoking and alcohol consumption honestly. Indicate any digestive issues and describe your exercise routine.
6. Check symptoms that apply to you in the various categories provided. Use the space below each category to elaborate on any major concerns.
7. Fill out dietary information by checking items included in your daily diet and describing typical meals in detail.
8. Address emotional well-being by answering questions about stress levels and satisfaction with life aspects.
9. List all supplements and medications you currently take, including dosages and purposes.
10. Finally, read and sign the statement of understanding at the end of the form before submitting it for review.

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