Pre-Session Update Form

Dear Client,

Hereby please find the required follow-up questionnaire to be completed before your next session.
Please kindly complete all questions two days prior to your next session. This will allow us to make the best use of our time together.

I’m looking forward to seeing you again.

What positive changes have you noticed since your last appointment?*
What are your main concerns at this time?*
What do you see as a significant barrier to you making more/faster progress toward your health goals?*
What changes have you made in your diet since our last session?*
Is your energy level higher or lower since your previous session? And to what do you attribute this change in your energy level?*
What changes have you made in your lifestyle in order to reduce physical, emotional and chemical stressors since our last session? Please include in your answers topics such as movement and exercise, sleep and rest, meditation and/or other relaxation exercises, spending time doing activities that bring you joy, etc.*
On a scale of 0 to 10, please assess your level of motivation you feel to make dietary and lifestyle changes that require time, discipline and dedication in your daily life?*
Please list all medications you currently take (prescription and/or over-the-counter) and frequency.*
Please list all supplements you currently take, including brand and dosage. Please do not refer to previously shared information.*
Do you have particular questions or topics you would like to cover in our next session?*
Name:*
Date:*

Welcome to DNA Care

Thank you so much for your interest in DNA Care. Currently we are not accepting new clients.

You may sign up for the waiting list via our contact form, and we will reach out to you as soon as we are able to schedule your intake session.

We look forward to welcoming you in our practice in the future.

Welkom bij DNA Care

Onze praktijk heeft momenteel een cliëntenstop. Via het contactformulier kunt u zich aanmelden voor de wachtlijst. We nemen contact met u op zodra het mogelijk is uw eerste afspraak in te plannen.

We zien ernaar uit u in de toekomst in de praktijk te verwelkomen.