Authorization for Services– Complete your name, address, phone number, who referred you, etc.
Build a Better You Wellness Evalutation—B.A.B.Y
The BABY program is designed for new or returning participants who would like to be evaluated, report sent by mail, and consults over the phone which can be recorded at not additional cost. The following five (5) documents are included in the Build a Better You and must be received and completed before your report can be evaluated.
- Authorization for Services– Complete your name, address, phone number, etc. and sign and date form to accept terms for report evaluation.
- Current Supplement List– List all Vitamins and Minerals that you are currently taking each day.
- Lifestyle and Symptom Survey – Answer questions that allow Dr. Brouse to quickly and concisely capture your current symptoms and health history.
- 7 Day Diet Summary– Summarize your food intake for seven days. This can be done the week before, during or after your blood draw.
- Monthly Nutrition and Lifestyle Log – A concise form that allows you to keep track of the most important aspects of your program and track your progress.
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