Follow-up Form Full Name: * Email: * Today's Date: Date of Last Session with Meera: Please describe what has improved in detail: What stays the same? What felt worse? Please describe in detail: Do you sleep well? Please describe whether your sleep is continuous, broken, restful, deep, etc. How many hours a night do you sleep? Please describe in detail any pain, stiffness or swelling? Please describe your digestion and bowel movements (constipation, diarrhea, gas, bloating, etc.): Any dietary changes/ updates? Please explain: Are any of the following part of your diet: gluten, grains, eggs, dairy, meat, poultry, pork, farmed fish, fish, corn, soy, canola oil, fermented foods, fermented drinks, alcohol, coffee, recreational drugs? Please provide a typical day with Breakfast / Snack / Lunch / Snack / Dinner: Do you take any supplements? Please list below, with brands and dosages: Please list any medications you are currently taking: What medical diagnostics, if any, have you had (including x-rays, MRIs, CT scans, blood-work or other)? Do you have a history of high blood pressure? Have you experienced difficulties in your work, home or social environments? Are you working with any other doctors, practitioners or healers? Please list your top 5 questions for this session: Do you have any additional questions or concerns? Thank you! I look forward to being in touch soon.
