Intake Form

Disclaimer: I am a trained Doctor of Chiropractic with numerous years and hours in nutrition therapy as well. I am not a licensed counselor or mental health professional. I do not diagnose mental health conditions or treat them. I do not assume liability for any harm that results from a decision to forego professional mental health treatment. I cannot guarantee that the suggestions I give will result in the same outcomes I, or others have experienced. I do wholeheartedly believe in divine healing and spiritual healing of the broken heart through Jesus Christ. I also believe in and encourage you to seek standard diagnostic evaluation and treatment if it is indicated.

All fees for services and supplements are the responsibility of the patient, payable in full at the end of the appointment. Payment can be made in the form of cash, personal check or credit card.

If you need to cancel or reschedule your appointment, 24 hours notice by phone is required to avoid incurring a cancellation fee. The fee is equivalent to the cost of the appointment missed. This helps cover clinic operation costs and avoids the need to increase consultation fees.