Step 1: Health History If you are new to Heilen, please answer the questions below so that we can get to know you better. Please answer the questions below: Go backYour message has been sent First Name(required) Warning Last Name(required) Warning Email(required) Warning Phone(required) Warning Are you currently being treated for any of the following: cancer, kidney disease, heart disease, and or pancreatic disease?(required) Yes No Was in past but not currently Warning Have you ever been diagnosed with an inflamed gallbladder or cholecystitis?(required) Yes No Warning Have you ever been diagnosed as having Schizophrenia?(required) Yes No Warning Are you currently type 2 diabetic?(required) Yes No Was in past but no longer Warning Have you ever been diagnosed as having hypertension or high blood pressure?(required) Yes No Warning Have you been diagnosed with hypothyroidism?(required) Yes No Warning If you are currently taking prescription medications, how many different medications are you currently on? (Do NOT include nutritional supplements)(required) None 1-3 4-6 7-10 >10 Warning If you could only choose one goal to achieve, what would it be?(required) Weight Loss Decrease Body Inflammation Increase Energy Improve Blood Chemistry Decrease Joint Pain Sleep Better Other Warning Is there anything that could prevent you from completing a health rebuilding program?(required) No Financial Lack of Support at Home Not Committed Work Life Stress Other Warning If you have any comments or concerns, please list below: Warning Do you have any food allergies?(required) Yes No Warning If YES to food allergies, please list foods that you are allergic to below. Warning Are you a female that is currently pregnant or nursing?(required) Yes No Warning If your employer/organization has already enrolled you, what is the name of your employer/organization? (optional) Warning Warning. Submit Δ You will be contacted within one business day! Thank You! Like Loading...
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