What is your current weight?*

What are your top 3 health concerns? Priority first.*

What solutions have you tried so far?*

List any Prescription or Over the Counter Meds you take more than 3 times a week.*

List any supplements you take daily.*

What surgeries have you had?*

How much water do you drink daily?*

How many meals per day do not contain packaged food?*

How many hours do you sleep a night?*

How many bowel movements do you have a day?*

Do you exercise at least 3 times a week?*

If you are a female, which season of life are you in? *

What symptoms are you currently experiencing?

Do you currently use HRT (hormone replacement therapy) or contraceptives?

Are you now, or in the near future planning to become pregnant?

Describe your menstrual cycle...

I understand that Dana Ellison is not a doctor and does not prescribe medicine, treat, or cure any illnesses. The information shared is for educational purposes to support your wellness and should not be taken as medical advice. I will discuss necessary dose changes for my medications and seek advice from a physician about my health concerns.*