Discovery Session Form-

* Required fields
Name *
E-mail Address *
What is your main complaint? *
How long has it been going on? *
How often does it bother you? *
What have you tired so far (that has not worked)? *
What does this prevent you from doing or enjoying? *
What or who would prevent you from completing a health rebuilding program? *
Describe what a typical day of meals consist of Breakfast,Lunch,Dinner, snacks and beverages? *
Are you currently taking prescription medications and or supplements please list them? *
If you decide to work with me what would want to achieve? *
What is your commitment level to working to achieve good health please rate 1 to 10 (10 being the best) *


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Dayspring Health Concepts

Laurean Millonzi

N88W16691 Appleton Ave

Menomonee Falls,Wi 53510

414-803-4783

www.dayspringhealthconcepts.com

dayspring7@yahoo.com