Please complete this form and submit it 48 hours before you consultation. 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 have filled out the required sections of this form you CAN NOT press 'enter' instead of the tab key while navigating the form. Pressing 'enter', anytime while filling out the form, 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.
NOTE: Please be aware that once you have filled out the required sections of this form you CAN NOT press 'enter' instead of the tab key while navigating the form. Pressing 'enter', anytime while filling out the form, 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.
If you want to add additional information after you have submitted your form, write the additional info
in an email here.
Disclaimer:
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.
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.