Gut Health Wellness Intake Form - Refresh Your Soul

I have been a client at Refresh Your Soul for over three years. I get a monthly colonic and sauna session. When I first came to Wendy, I sought relief from chronic constipation and bloating. With Wendy’s guidance and experience, I began my monthly sessions of colonics. I was nervous and unsure, but Wendy quickly made me comfortable with the treatment I would be receiving. Over three years later, my constipation is gone, and the bloating is almost non-existent. At 53 years old and in menopause, I feel healthier and better. I am at a comfortable weight and with Wendy’s encouragement, I have changed my diet and use fiber and a greens supplement in smoothies. I look forward to her cookbook that is coming out so I can incorporate her recipes into my diet. I will always be a work in progress, but the Colonics have helped me achieve a level of health I had not experienced in a very long time. The staff at Refresh Your Soul is friendly and knowledgeable and works hard to make your experience good. The office is clean and organized. Wendy is caring and educates by learning new techniques to help her clients. I enjoy my time with her, and I always leave feeling refreshed and renewed. Thank you, Wendy, for always helping people and being a true joy to your clients!!

Section 1: General Info

Section 2: Medical & Health History

Section 3: Gut Health & Symptom Review

If you answered YES to being under medical care or checked any major conditions above, please provide details below:

List all medications you are currently taking

List all supplements you are currently taking

Section 4: Lifestyle & Habits

Sleep

Exercise

Hydration

Stress

Other

Nutrition Background