Please complete this questionnaire prior to your appointment. This information will contribute to the development of a nutrition program based on your needs and current lifestyle habits. Please feel free to include additional information that you feel might be relevant to your nutrition assessment.
Disclaimer: You certify that the information provided is correct to the best of your knowledge and understand that to falsify information is grounds for denial of consultation. You further acknowledge acceptance of a solicitation from Affordable Marijuana License in regards to medical marijuana.