It's My Health
Healthy for life!
Instuctions
Click on the appropriate links for the "Client Info/Release form" and the "Questionnaire" of your choosing.For a printable "Client Info/Release form" in pdf format click here.
Please note: the "Client Info/Release form" MUST be filled out completely, initialled in all the right spots and signed in order for me to do your consultation. Failure to include this completed form will result in a return of your papers with no consultation.
For a printable "General State of Health Questionnaire" in pdf format click here.
For a printable "Health Education Questionnaire" in pdf format click here.
Complete all pages as accurately as possible. The more information you can provide, the more helpful my suggestions can be.
Ensure that all information is complete and clearly written/printed.
Mail the completed forms, along with a money order or cheque for:
Option #1 - - $80.00 Canadian to have results sent to you by postal service or
Option #2 - - $75.00 Canadian if you want results sent via Email
TO:
Colleen Kirtzinger
Box 144
Farmington, BC
V0C 1N0
Please understand that sending this form by mail and paying with a cheque will take longer than submitting the information on-line and paying through PayPal.
Once I receive your completed form and payment, your cheque will have to clear my bank and I will compile suggestions for your consideration based on the information you have provided. Then the suggestions will have to travel back to you through the mail unless you chose to provide an email address with your contact information.
To Your Health!
Colleen Kirtzinger
It's My Health
Health is the greatest gift, contentment the greatest wealth, faithfulness the best relationship.
Buddha (563 BC-483 BC)
Founder of Buddhism.
Buddha (563 BC-483 BC)
Founder of Buddhism.
Information contained in this website is intended for education purposes only. The content on this site is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health care provider when you have questions regarding a medical condition.