Revisit Form Revisit Form Welcome back! And congratulationson your commitment to living a Smart Life!Please fill out the form completely so I can see where you’re at with your goals and how to help you reach your fullest potential. We are in this together!Personal InformationName* First Last Email* Health InformationGeneral questions about your health before your next sessionWhat positive changes have you noticed since your last session?What are your main concerns at this time?Any changes with weight?Constipation or Diarrhea?--YesNoHow is your sleep?How is your mood?Food InformationGeneral questions about your food habits before your next sessionAre you cooking more?--YesNoWhat foods do you crave?What is your diet like these days?Breakfast, lunch, dinner, snacks and liquids.BreakfastLunchDinnerSnacksLiquidsAdditional InformationAnything else you would like to share? If you have problems submitting the form, you can download it HERE. Please Save it to your computer and email it to the address on the form once complete.