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cosmetic acupuncture navigation bar Home Page About Dr. Back, Naturopathic Doctor Principles, Training, & Practice Acupuncture Cleanse Class Information How and Why to Cleanses Who should see a naturopath Wellness Packages & Special Offers New Client Form
New clients for Back to Balance, Dr. Hilary Back
Dear New Client:

It is extremely helpful if you prepare some information before your first appointment, to ensure that the visit is as thorough and useful as possible. Click here for the attached questionnaire* . Please complete the questionnaire and fill out the diet diary for any three days in a row between now and your scheduled visit. The diet diary is both a list of what you eat meal by meal and brief notes on how you felt on those days. If existing symptoms are worse at any particular time, please note when.

If another provider has ordered laboratory work in the previous twelve months, please call their office and ask that a copy of the results be sent either to you or to me, hopefully before the first visit.

Thank you for putting your time into this preparation. Please remember to bring it with you to your appointment on _______________________ at__________. These forms greatly facilitate the visit.

If you need to cancel this appointment, please call 24-hours in advance. Barring emergencies, there will be a $120 charge for missed first appointments that are not canceled 24 hours in advance.

I look forward to meeting you.


Hilary Back, N.D., L.Ac.
*Download Adobe Acrobat Reader

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