Health Informational Form

Please fill out the Health Informational Form to provide health history, concerns, and goals.
  • Within 3 business days, you will receive an email to set up a consultation, at the email address provided. If you prefer to call to make an appointment, please feel free to do so, at (813) 563-2019.
  • Please share additional information and any relevant test results via email at: Relevant tests could include vitamin and mineral panels, food allergy tests, food sensitivity tests, etc.
  • Consultation and/or lab testing fees, if applicable, will be sent via invoice to the email provided once an appointment is confirmed. Lab testing fees are due upon receipt of the invoice. Lab kits will be mailed directly to the client within 2 business days, via UPS. Consultation fees are due no later than 72 hours prior to the confirmed appointment date and time.
**Disclosure: Any medical diagnoses will need to be by way of a medical professional such as an M.D., D.O., or another medical specialist. Any test results regarding diagnoses, examples; celiac panel, CBC, etc. will need to be reviewed by your medical provider. Any consultations provided by The Nutritional Advisor are solely for dietary and nutritional purposes. Submitting this form confirms that you have read the details and disclosure provided above and agree to them.
Medical conditions:

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Requested Lab Tests (testing kits are mailed directly to client):