Confidential Health Update Form

If you are an existing client, please fill out the health update form below and submit within 24 hours of your next scheduled appointment.

* Required Fields

Basic Information

* Client Name:
* Email Address:
Telephone:

Current Health and Lifestyle

What positive changes have you noticed since your last appointement?
What are your main concerns at this time?
Any changes with weight?
How is sleep?
How is your mood?
Do you experience constipation/diarrhea? Yes No If yes, please explain
Are you cooking more?
What foods do you crave?

Diet

What's your diet like these days?

Breakfast

Lunch

Dinner

Snacks

Liquids

Additional Comments

Any additional comments or questions?

 Please type the alphanumeric combination from the Captcha Image.

About Me

Stephanie Lazzara
Nutrition Counselor
(917) 975-9256

I am a graduate of the Institute for Integrative Nutrition.

My practice is deeply rooted in the mind-body connection to food and how we choose to live our lives.

I believe in the body's true abilty to heal itself when given the proper support and information.

I currently live in Brooklyn, NY with my husband and son.

Events

Please join me for healthy eating tips, recipes and more!

View All Events

Recent Blog Posts & Health News

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