fine.......here is my questionnaire. Send it to me answered to my elitefitness.com email account if you dont want to send it to hotmail....but i prefer hotmail cuz it is much easier and faster to answer. Here is the form i have been sending out.
Fill this out completely please. Ill get back to you as soon as i can. I will be charging $40 for the frist 2 scripts AND reviewing your medical history, AND answering any questions related to this, AND reviewing any labs you want me to look at. $20 for each additional script. You can paypal me at
[email protected] and i will call in the script. 3 month supply maximum. Im flexible since this may be a long term thing for me and i want good references. Some of these things may be different from previous emails since im still feeling out what is fair and what is too expensive. Is that fair? Let me know what you think.
Name:
AGE:
Sex:
if female, are you pregnant?:
plan on being pregnant and when?:
last pregnancy date:
currently breastfeeding?:
Blood pressure and pulse and when it was taken:
Medications:
Supplements:
Over the counter:
Allergies:
Family History(grandparents, parents, brother, sister) of cancer, heart disease, high blood pressure:
Past and Current medical problems(IMPORTANT....do not leave blank):
Hospitalizations and/or surgeries....when and for what:
Have you had any of these and please explain BRIEFLY if yes.....i will ask in more detail if necessary.
shortness of breath:
chest pain:
problems such as pain urinating or inability to urinate:
kidney, liver, or lung problems:
seizures:
anxiety, panic, or suicidal thoughts:
blood clots in legs or venous thromboembolisms:
recent large weight loss:
any lab results, ekg, X-rays, MRI's, etc and when were they done:
Antyhing else you think might be important or i forgot to ask:
Local pharmacy number if you want me to call it in:
OR home address:
T