Revisit Form
Please list all medications and supplements you are taking now
What positive changes have you noticed since your last appointment?
What are your main concerns at this time?
Any changes with weight and/or waist size?
How is your sleep?
Constipation or diarrhea? Gas or bloating? Which?
How is your mood?
Is your energy level higher or lower lately?
To what do you attribute this energy level?
Are you in any pain on a regular basis? Please describe.
If this is ongoing pain, is it better, same, or worse than before?
Are you receiving good support from those around you for the changes you are making?
Are you taking all supplements consistently? Any concerns?
What do you see as a significant barrier to you making more/faster progress toward your health goals
Are you cooking more?
What do you crave? What are you doing or feeling when you crave?
Do you keep a food journal? *
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