Client Intake Form — the doctor's daughter
the doctor's daughter
Functional Medicine · Metabolic Health · Lifestyle
Client Intake Form Lisa Watson · Worldwide Consultations

Welcome — Let's Read Your Whole Story

Confidential · Please complete before your first session · info@doctorsdaughter.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 info@doctorsdaughter.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

Metabolic & Hormonal Health

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

Gut & Digestive Health

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
10

Mental Health & Mood

Current mood concerns:
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 · the doctor's daughter

Would you like a copy for your own records? (Optional — Lisa already has your form.)

Click above → a new window opens → press Ctrl+P → choose "Save as PDF"

the doctor's daughter  |  Lisa Watson · Worldwide Consultations  |  doctorsdaughter.ca  |  info@doctorsdaughter.ca
Romance Your Body with Discipline · © Lisa Watson — All information is confidential.