herbal consultation intake form

Frieda Kipar Bay  •  friedabay.wovenroot@gmail.com

Please take the time to read and complete the following:

• Fill out the enclosed intake form prior to your initial consultation. Please only fill out what you are comfortable with.

• Please note any place you have a question and we will be sure to address it. We will go over this form together during the consultation.

• If you are taking herbal medicines or supplements regularly, please bring in the original container they came in or write down the company info so I can see exactly what you are taking.

• Client confidentiality will be observed under all circumstances.

Please understand that Frieda Kipar Bay is not a doctor, nor does she take the place of your doctor.  This statement is required by law.