Client Forms

KNOWLEDGE IS POWER

New Clients: Please click below to download and complete the Health History form prior to your first coaching session.

Returning Clients: Please click below to download and complete the Revisit form before you next Coaching Session.

Please complete this Health History form prior to our first  Coaching Session

Health History - WOMEN

Please complete this Health History form prior to our first Coaching Session

Health History -
MEN

Please complete this form before your next

Coaching Session

Revisit
FORM

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©2018 BY WILD LILAC WELLNESS. PROUDLY CREATED WITH WIX.COM
I, ZARYA RUBIN, AS AN INDIVIDUAL ON THIS WEBSITE DO NOT PROVIDE MEDICAL ADVICE. I AM FUNCTIONING AS A HEALTH COACH AND AS SUCH WILL ONLY BE PROVIDING INFORMATIONAL AND EDUCATIONAL MATERIAL. I WILL NOT BE ESTABLISHING A PATIENT-PRACTITIONER RELATIONSHIP IN ANY FORM. THE INFORMATION ON THIS WEBSITE HAS NOT BEEN EVALUATED BY THE FOOD AND DRUG ADMINISTRATION AND IS NOT INTENDED TO DIAGNOSE, TREAT, CURE OR PREVENT ANY DISEASE. THANK YOU FOR YOUR UNDERSTANDING; AND I LOOK FORWARD TO PROVIDING YOU WITH INFORMATION THAT WILL BRING WELLNESS TO ALL ASPECTS OF YOUR LIFE! 

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