DUTCH Consult Intake Form - Passionate For Truth

DUTCH Consult Intake Form

Please fill out the information below as completely and honestly as possible.  The more information you can give, the easier it will be for us to work out the best health improvements possible for you!

Once I receive the completed form, I will contact you to schedule your consultation.


If you have checked any of the above items, please provide details in the space below.
If you checked any of the above, please explain details in the box below.
All of these questions help me to get a good sense of who you are and possible things that can help improve your health.

I am not a licensed practitioner, physician, dietician, nurse or medical professional. In the course of our relationship I will offer no medical treatments, nor will I diagnose you.

My training regarding the DUTCH test has been with Maria Claps, Natural Hormone Expert, and through my studies of the teachings available by the medical professionals from Precision Analytical, in order to understand the results of the DUTCH test.  Any understanding that I share with you is for you and/or your medical professional to determine the best course of action based on the findings of the test.  My relationship with Precision Analytical is strictly as a vendor, not as a medical professional.

If you have a medical condition of any kind, you must maintain treatment as prescribed by your physician regardless of my recommendations or advice, or any use of recommended online guides, supplementation, websites or products. In the case of medical diagnoses, it is vital to work with your physician to determine the best course of action; and to never replace one treatment for another that goes against your physician’s advice.

None of the recommendations, suggestions or written information provided are intended to replace medical advice of any kind. Wellness counseling is not a prescriptive service; all consultations written or otherwise should be considered as purely informational and carried out at the individual’s own risk. The information presented is never intended to diagnose, treat, cure, or prevent any disease.