Dear New Client:
I have found it extremely helpful to have you prepare some information before your first appointment, to ensure that the visit is as thorough as possible. Below is a questionnaire in the New Client Forms, including a diet diary section. Please complete the questionnaire and fill out the diet diary for any three days in a row between now and your scheduled visit.
In addition, please write out a brief timeline of your own history, beginning with birth or early childhood. This history should include major illnesses, injuries, and/or hospitalizations, significant turning points or events in your life, any periods of heavy usage of alcohol, cigarettes, coffee, and pharmaceutical or recreational drugs. For women, please include events related to your reproductive system (first period, menopause, pregnancies, abortions, birth control, etc.) If you are filling this out for your child, please include any notable information about the pregnancy and nursing. If you are currently breast feeding your baby, please fill out the diet diary with your diet. Again, keep it brief and simple, we will go into detail as needed.
Please bring a list of your current medications with dosages and bring with you any supplements and vitamins that you are currently taking. Also please bring any lab work you may have even if it is dated.
Thank you for putting your time into this preparation. Please remember to bring it with you to your appointment. Experience has shown that the form, and the timeline in particular, greatly facilitates the visit. In addition, please be sure to eat before your appointment.
Please refrain from wearing perfume, scented oils or strong smelling lotions for your visits to the office.
If you need to cancel this appointment, please call 48 hours in advance. Barring emergencies, there will be a $200 charge for missed first appointments that are not canceled 48 hours in advance.
I look forward to meeting you.
Sincerely,
JoHannah Reilly ND, LAc
Checklist For Initial Visit
- Complete the intake forms before your appointment
- Bring current vitamin supplements and medications
- Read Instructions For Initial Visit
- Bring intake forms
- Bring recent lab and blood tests
- Wear loose-fitting, comfortable clothes
- Please do not wear strong perfumes
- Be sure to eat a meal before your appointment
Initial Visit Forms
Please print out the New Patient Forms and fill them out in advance of your first appointment.
JoHannah Reilly ND 