Client Intake Form — Lisa Watson
Lisa Watson
Functional Medicine · Metabolic Health · Lifestyle · Hypnosis & NLP
Client Intake Form Lisa Watson · Worldwide Consultations

Let's Read Your Whole Story
and discover your best self

Confidential · Please complete before your first session · lisa@lisawatson.ca

How to submit: Complete all 15 sections and click Submit My Intake Form at the end. Your form will be sent directly to Lisa — no extra steps needed.
Questions? Email lisa@lisawatson.ca  ·  Best completed on laptop or desktop.

Section 1 of 15
1

Personal Information

2

Health Goals & Primary Concerns

1 (poor) 10 (excellent) 5
3

Medical History

Current or past diagnosed conditions:
4

Medications & Supplements

5

Metabolism & Mitochondria

Energy patterns throughout the day:
Do you experience any of the following?
6

Microbiome

Bowel movement frequency:
Stool consistency:
Digestive symptoms:
7

Nutrition & Lifestyle

Current dietary approach:
Percentage of meals home-cooked:
Foods regularly consumed:
8

Sleep

Sleep concerns:
9

Stress & Nervous System

1 (none) 10 (extreme) 5
1 (isolated) 10 (deeply connected) 5
10

Mind & Mindset

Current mood concerns:
1 (not stuck) 10 (very stuck) 5
11

Environmental Exposure

Known exposures:
12

Family Health History

Conditions in immediate family:
13

Current Health Team & Recent Testing

14

Your Health Story

This is the most important section. Take your time. Your whole story matters here.

15

Readiness & Support

How ready are you to make lifestyle changes?
Support at home:

Confidentiality: All information is strictly confidential and used solely to support your health. By submitting you consent to Lisa Watson using this information for your consultation.

Thank you for sharing your story.

✓ Your form has been sent to Lisa — no further action needed.

Lisa will be in touch before your appointment.

"They kept treating the chapters. Nobody read the whole story."

I read the whole story. See you soon.

— Lisa Watson

📋 Before you go — save a copy of your answers for your own records

Lisa Watson · Worldwide Consultations  |  lisawatson.ca  |  lisa@lisawatson.ca
Romance Your Body with Knowledge, Power, and Inner Discipline · © Lisa Watson — All information is confidential.