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Step 1: Health Intake
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Step 2: Schedule Call
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Clinical Health Assessment

Intake Questionnaire

This intake form helps Dr. Sana Afreen understand your baseline health, medical background, and dietary goals before your consultation. You can also submit this standalone form so our clinic team can get in touch with you!

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If you prefer to discuss on the call, you can select that option below.
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kg
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cm
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inches
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The chief complaints or health objectives you'd like us to help solve.
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Lacto-vegetarian: includes dairy, no eggs/meat. Ovo-vegetarian: includes eggs, no dairy/meat.
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Leave blank if none.
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