Oracle Health Intake Form
This 10-20 minute form is the first step in understanding your total health picture. By completing it, you will allow us to analyze your individual needs, while also being prompted for things you might have not known could be addressed!
Email *
Were you referred by any of our online affiliates? *
Full Name *
Date of Birth *
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DD
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Height (inches) *
For this measurement, your height MUST be selected in inches. (Ex. 5'0" = 60" and 6'0" = 72" , etc.)
Current Body Weight (lbs) *
Goal Weight *
Abdominal Circumference (inches)
Greatest circumference around your midsection between your ribs and your hips
What is your blood type? *
What is your Blood Pressure? (mm/Hg)
Make sure you have been seated for at least 5 minutes before measurements are taken
What is your Resting Heart Rate? (bpm) *
Make sure you have been seated for at least 5 minutes before measurements are taken
Do you have a wrist-based activity tracker? *
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