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New Client Forms

Please submit the Health Declaration prior to your appointment.

Health Declaration

Please fill out the following form & submit the required consents prior to all services.

First Name

Last Name

Email

Date of Birth

Address

Phone

Current Height & Weight

Have you been hospitalized in the last 12 months?

No

Yes

Do you have any medical condition, illness, or injury?

No

Yes

If you answered yes to any question, please elaborate

List any medications or supplements you take.

Allergies

I declare that the info I’ve provided is accurate & complete

I agree to the terms & conditions outlined in the consent form(s) and privacy policy.

Date

Your Signature

Upload File

Thanks for submitting!

CLIENT FORMS

REQUIRED PRIOR TO ALL SERVICES

Prior to starting any health service, please click the link(s) below to download and complete the consent form(s) for your elected plan. You may upload the signed forms to the drop-box(es) at the bottom of the Health Declaration or email the forms to info@drelizabethdonathan.com. Thank you

New Client Forms

Health Declaration

CLIENT FORMS

New Clients

Weight Loss

Men

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