CLIENT INFORMATION 3

Client Information Form

Welcome to Invigorate Naturopathy. Please help us provide you with the most appropriate treatment possible by taking the time to complete this information questionnaire carefully and completely.
Any information you provide will be treated with complete confidentiality and not used for any other purpose other then those stated on this form.

Please list any current prescription medications, over the counter medications or supplements you are taking. (Please list full name and brand if possible, dosage and when you commenced treatment)

Please fill out the form on the previous page