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First Name
Email
Date of birth
What program do you use to video chat?
FaceTime
Skype
Zoom
Other
I prefer not to
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Height
Last Name
Phone
Gender
Female
Male
Nonbinary
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What's our video chat user name?
Weight
Describe your chronic symptoms
Were you a full-term baby?
Yes
No
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What medications are you currently taking? (including birth control)
How often do you take antibiotics?
Were you bottle or breast fed?
Bottle
Breast
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Do you have trouble sleeping?
No
Sometimes
Often
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Rate your current stress level
Little to none
Moderate
High
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If I could help you with one thing, what would it be?
Package price: 90 minute consultation $198
Terms & Conditions
Chris Tracy is an
integrative
health practitioner and does not diagnose, cure, or treat any illness or disease. Further, the undersigned releases Chris Tracy, his independent representatives, associates and affiliates from any and all liability for any failure to identify any medical condition or disease. It is understood and agreed that this is not the purpose of their integrative health services.
I accept the terms & conditions
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