MN Intake Form
for Herbal Case Study

START HERE:  Welcome to our convenient online MN Intake Form.  This form takes an average of 20-90 minutes to complete.  Please make sure you have set aside the time to complete this form accurately.  This form gathers information for your wellness records that will assist in your herbal and wellness therapy.  Once you have completed the form, simply click the "Submit" button to securely and confidentially send the information to your wellness practitioner or herbalist.  Please note that this form is for MN appointments only.  

NOTE:  This is a confidential form for your wellness information and history and will be kept on file in our office.  Information herein will not be released to any person unless you have authorized to do so.  Submitting this form authorizes the form to be placed into your file and for your herbalist and/or wellness practitioner to review.  The complete the questionnaire as thoroughly as possible.

MN Intake Form

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