CLIENT FORMS

Referrals and Client Forms

Are you a medical provider or healthcare professional interested in referring your patient or client to our services? Contact us and we will find the best holistic solution to suit their needs.

Integrative Health and Wellness Assessment™

Prior to or during your new client consultation appointment you will be asked to complete an Integrative Health and Wellness Assessment™ (IHWA)-short form which will be used to evaluate and assess areas of your life including: life balance/satisfaction, relationships, spiritual, mental, emotional, physical/nutrition, physical exercise, weight, environmental factors and health responsibility.

This self-reporting tool assists our clients in assessing healthy behaviors through a self-reflection process, provides information for the coaching relationship, and may be an outcome measurement for future coaching sessions. Please allow 10-15 minutes to complete the assessment online.

Complete Assessment Now

Client Consent Form

This Client Informed Consent Form is a document to properly acquire consent from you for holistic wellness, stress relief and energy treatments. The form contains information about the services and the agreement to be made by myself and you as the client. Services will not be rendered until clients have provided informed consent. Please sign and bring your completed form to your first appointment or email at info@designandwellness.com

Confidential Client Health History and Intake Form

A client health history and intake form is a document that I use as a private practice nurse and holistic practitioner to keep track of the previous health conditions of my clients and to learn how I can best help them. Your health history and intake form is maintained with strict confidentiality based on HIPPA laws. Please sign and bring your completed form to your first appointment or email at info@designandwellness.com

New Yoga Client Information Form and Release, Waiver

Yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. A Release and Waiver must be completed and signed before participating in any Yoga Therapy session. Please sign and bring your completed form to your first appointment or email at info@designandwellness.com

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Info@designandwellness.com

Design & Wellness

Referrals and Client Forms

Integrative Health and Wellness Assessment™

Client Forms

Client Consent Form

Confidential Client Health History and Intake Form

New Yoga Client Information Form and Release, Waiver

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