Health History Assessment | Lyndsy Moffatt

About You

A few details to help me understand who this assessment is for.

First name *

Last name *

Email *

Phone *

Location / City, State

Who is this assessment for? *

My childMyselfA family member

Share the information that will help guide our conversation.

Primary diagnosis or health concern *

Other diagnoses or conditions

When did symptoms begin?

Main symptoms you're experiencing

Current diet description

Known food sensitivities or intolerances

Current supplements

Current medications

Let me know about any functional labs you have completed or have on the way.

Have you done any functional labs?

YesNoSome ordered, not yet received

Summary of key lab findings

Your priorities and previous experiences help me prepare for our work together.

What is your primary goal for working with Lyndsy? *

What have you already tried?

What results did you see?

What is your biggest challenge right now?

Anything else you'd like Lyndsy to know?

How did you hear about Lyndsy?

What is your approximate investment comfort level for support?

This helps me understand which options may be the best fit for your family. There is no wrong answer.

Email used when booking

This helps Lyndsy link this to the booking.