Please complete this form and submit it 48 hours before your consultation.
Please keep your timeline very brief; no complete sentences - just give me the highlights.
Believe me, we will discuss your life in depth when in person. :)
You will know you have submitted it successfully when you see a
Thank you message after clicking the Submit button!
NOTE: Please be aware that once you CAN NOT press 'enter' to navigate through the form. Pressing 'enter' will prematurely submit your form. IF you do press enter and submit before you are ready, you can go to the form again and start where you left off. We will put them together in one form when it is received.
To navigate in the form, press your TAB button.
Please keep your timeline very brief; no complete sentences - just give me the highlights.
Believe me, we will discuss your life in depth when in person. :)
You will know you have submitted it successfully when you see a
Thank you message after clicking the Submit button!
NOTE: Please be aware that once you CAN NOT press 'enter' to navigate through the form. Pressing 'enter' will prematurely submit your form. IF you do press enter and submit before you are ready, you can go to the form again and start where you left off. We will put them together in one form when it is received.
To navigate in the form, press your TAB button.
Disclaimer and Cancellation & Refund Policy:
Please know that the information you receive in your consultation is not medical advice; instead, it is a sharing of knowledge and information from the education, research, training, and experience of Andi Locke Mears. This is not intended to replace the relationship with your primary health care providers.
You have the right to make your own health decisions based upon your research and in partnership with your primary health care providers, ND, MD or otherwise.
I, by clicking the submit button, reserve the right to seek or ask nutrition or wellness care advice, counsel, recommendations, suggestions, assessments, evaluations, test and/or treatments, regimens or modalities from the nutritionist or doctor or health care provider of my choice for any health reason or purpose.
I acknowledge that the information and service provided by Andi Locke Mears is not used to prescribe, recommend, diagnose, or treat a health problem or disease. It is not a substitute for medical care. I agree to hold Andi Locke Mears harmless from any present or future liability.
Cancellation & Refund Policy:
Cancellations or changes to scheduled appointments must be made 24 hours in advance of the scheduled appointment. Otherwise, you will be billed for the cost of service as a cancellation charge. Any check returned for insufficient funds will be subject to a $35.00 processing fee. If you are calling after business hours, please leave a message on my voicemail indicating your appointment cancellation. The same charge applies for missing an appointment. All payments for services are nonrefundable. Thank you.
Please know that the information you receive in your consultation is not medical advice; instead, it is a sharing of knowledge and information from the education, research, training, and experience of Andi Locke Mears. This is not intended to replace the relationship with your primary health care providers.
You have the right to make your own health decisions based upon your research and in partnership with your primary health care providers, ND, MD or otherwise.
I, by clicking the submit button, reserve the right to seek or ask nutrition or wellness care advice, counsel, recommendations, suggestions, assessments, evaluations, test and/or treatments, regimens or modalities from the nutritionist or doctor or health care provider of my choice for any health reason or purpose.
I acknowledge that the information and service provided by Andi Locke Mears is not used to prescribe, recommend, diagnose, or treat a health problem or disease. It is not a substitute for medical care. I agree to hold Andi Locke Mears harmless from any present or future liability.
Cancellation & Refund Policy:
Cancellations or changes to scheduled appointments must be made 24 hours in advance of the scheduled appointment. Otherwise, you will be billed for the cost of service as a cancellation charge. Any check returned for insufficient funds will be subject to a $35.00 processing fee. If you are calling after business hours, please leave a message on my voicemail indicating your appointment cancellation. The same charge applies for missing an appointment. All payments for services are nonrefundable. Thank you.