Re-intake Form for Adults RE-Intake form 2018 This is the full reintake form for 2018 Date Name First Last PhonePlease offer an overview of any current physical symptoms and what you are already doing for them (if you are not doing anything yet, just list the symptom thank you!).*Please offer an overview of any life changes you are seeking to make now or in the future that you would like to discuss with Jenifer.*Please offer any challenges you are currently dealing with that you would like assistance with.*Please provide all supplements you are currently taking including time of day - for example: structural caps, made by Jen, 1 per day with lunch.*Please provide brief overview of current eating habits - ie. gluten free, dairy free, etc.*Please provide any additional information you feel would be useful for Jenifer to know. Thank you!*CAPTCHA
