(949) 633-1332

185 Paularino Bldg. C, Suite 102

Costa Mesa, CA 92626

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©2019 Path to Health

Below are links to all of the forms I will need for your first visit. Your Appointment has been scheduled under the assumption that your paperwork will have been completed prior to your appointment time.

 

When filling out the symptom survey form, please follow the directions carefully. Mark “1” in the box for mild and occasionally occuring symptoms, “2” for moderate symptoms or “3” for severe and constant symptoms. If the symptom does not apply to you, leave the box blank.

 

Please have all of the forms completed before you come in for your appointment so we can spend our appointment time coming up with a game plan rather than filling out forms. :)

 

 

Please bring these forms with you:

 

  • Your completed new client forms (below)

  • Any recent blood work (done in the last 6-9 months)

  • Any vitamins, supplements, or medications you are currently taking. You may fill out the substance form below instead, but please provide specifics like the brand names.

 

Your initial evaluation will be $150, where we will go over your blood work, current health issues, diet, health history, stress, sleep, exercise regimen, vices, and all other necessary information. We will then go over your deficiencies, the causes of your issues, and set goals for the first 10-14 days. Please allow 90 minutes for the initial consultation and 45-60 minutes for subsequent visits. If you have any questions, please give me a call.

 

I look forward to getting you started on your path to health!

 

 

Carrie Wojciechowski,

Clinical Nutritionist

 

 

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New Client Forms: (click on and print)