Health Intake
*All questions require a Yes, No, or N/A response.
Step 1 of 6

Please select if you have or have had any of the following conditions or circumstances:

Clients with any of the medical conditions listed below will be sent to their primary care doctor or specialist along with the Ideal Wellness NW Protocol Overview and the Authorization to Use Protected Health Information medical release form.

Request an Appointment

If you’re a current patient, please do not use this as a form of communication.