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Welcome to the Wellness Progression. As we begin a partnership towards optimal health, it is important to have a better understanding of your previous wellness journey.  Please take a moment to complete our Personal Intake Form. Please fill this form completely and to the best of your knowledge. Once complete, please hit submit and your forms will come directly to Dr. Brian.

Personal Information
Marital Status
Technology Aptitude
Do you have internet access?
Have you used Zoom before?
Contact Information

* We will NOT share your email  or phone number with any third party. We will only use your email to contact you in relation to your care with our practice.

Emergency Contact
Employment Information
Employment Status
Personal Health History
Are you pregnant, or have you had any signs of pregnancy? (Female Only)
Are you planning to get pregnant in the next 12 months? (Female Only)
Please select all that you have had or currently have.
Have you had any of these Cardiovascular Diseases? Please select all that apply.
Family Health History
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