<a href="http://fs7.formsite.com/gwastl/form972347829/index.html">Click here to complete: New Patient Form</a>
✽ It is important you realize that the opinions offered on my website are for information purposes only and should not be construed as healthcare advice. Please remember, if you use this information without your doctor’s approval, you are prescribing for yourself, which is your constitutional right.
✽ Nutri-Energetics Systems® (NES) does not diagnose, cure, prevent or treat disease. If you have a medical condition or concern, please consult the appropriate healthcare professional. NES and its claims have not been evaluated by any government agency or regulatory organization.
Filling in the New Patient Form
The New Patient Form to the left must be filled in by all new patients.
Be as complete as possible in answering the questions. The more honest and accurate you are, the better I will be able to help you.
When you are finished filling in the form type in the CAPTCHA phrase (this helps prevent spamming) and press the SUBMIT button. I will be sent a copy of the form which I will print out and review before your first appointment.
If you have any questions as you are filling in the form email me by CLICKING HERE (this is the fastest way to reach me) or call me at 651-287-1311.