Nevada, United States
List any food allergies or intolerances:
Have you made any dietary changes recently that you feel good about?
I have read and fully understand the above. I agree to abide by these terms.
Have you followed any other wellness programs?
Where do you usually eat out?
I want information on:
Path to Healthier You: Free
One Session with Your Personal Holistic Nutrition Consultant
Real Nutrition/Real Health Starter Pack
Real Nutrition/Real Health 30 Day Plan
Essential Oil Class: Free
On a scale of 1-10 (1=low, 10=high), how motivated are you to make changes?
You will not be asked to schedule a visit with any doctor. Any and all, services or testing, with a personal medical doctor are your responsibility.
A 90 Day and a 180 Day plan are available - first month's payments due up front (with a minimum of two month commitment)
List any prescribed, over the counter, herbal/mineral supplements you currently take:
Who prepares most of the meals in your home?
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What health concerns do you have at the present time?
Do you experience any of the following?
Allergies (seasonal or otherwise)
Anxiety, depression or other mood issues
Fatigue or lack of energy
Migraines or regular headaches
Muscle or joint pain
PMS or other menstrual issues
Skin issues (acne, eczema, psoriasis , rashes, etc)
Other (please explain below)
No, I do not experience any of these
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Do you normally skip any meals?
Do you drink alcohol?
Information contained on www.holisticinstincts.com (the “Site”) is based on the knowledge, research, and the professional and personal experience of Janette Razo (The terms “I”, “me”, “my” and “mine” refer to Janette Razo, Certified Holistic Nutrition Consultant). Some of the nutrition information on this site may not be approved, recommended nor endorsed by the United States Department of Agriculture, Food and Drug Administration, American Heart Association, American Diabetes Association or the Academy of Nutrition and Dietetics. The information on my site is not intended as medical advice. Always consult a qualified healthcare professional before changing your diet or medications or beginning any exercise routine. I assume no liability for the use or misuse of any information found within this site. This Site may contain links to other sites. I do not control, monitor, or guarantee the accuracy of the information contained in external sites, and do not necessarily endorse the views expressed on those external sites.
Other health issues, if any (Please explain):
Do you have someone that supports and encourages your changes?
How often do you eat out (fast food or casual dining restaurants) per week?
How many people in your household?
How often do you use prepared or convenience foods per week?
Once payment is made, please know that refunds (or partial refunds) are not issued if you decide to break the commitment, do not follow the plan given, or you decide to discontinue the plan any time before your scheduled end date.
Nevada, United States
Additional information you would like for me to know:
Are there certain foods that you do not eat?
Who is in charge of the grocery shopping for your household?
What are the usual reasons for choosing to eat out or skipping a meal?
How did you first hear about Holistic Instincts?
You will be supported through your plan but you are responsible for making a commitment to follow through. You will need to be consistent with your plan and know that if you are not, positive results cannot be expected.
Thank you! I look forward to going over your concerns and I will contact you within 2 business days.
Do you now, or have you ever, follow a special dietary plan (example: low-fat, low-salt, vegetarian)?
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