| Contact Form: |
I would like more information about:
| |
Nutrition Consulting Sessions (to learn more, Click Here) |
| |
Personal Cooking Classes (to learn more, Click Here) |
| |
Personal Shopping (to learn more, Click Here) |
| |
3 Time Package Deal (to learn more, Click Here) |
|
| |
I am currently under the care of a physician for a health problem or medical condition. |
| If so, for what problem or condition? |
| |
Nutrilligence, has my, the Client’s, permission to contact my physician about the work we are doing and to obtain client/patient records. |
| |
I, the Client, have read and understood the terms set fourth in the Client Informed Consent and Statement of Intent. |
|
| |
 |
|