New Client Consultation Intake Form
Thank you for choosing Solari Wellness. This intake form helps me better understand your health history, lifestyle, goals, and current concerns so that I can provide personalized wellness recommendations.
If you are unable to upload records, you may email them to solariwellnessco@gmail.com. Please include your full name in the subject line.
Skip this section if you are not a biological female
Fun fact, a healthy menstrual cycle can be between 21-35 days long, as long as it's consistent. The key factor isn’t having a perfect 28-day cycle—it’s consistency. For example, a woman who cycles every 25 days regularly may be just as healthy as someone who cycles every 32 days.
Did you know: regular use of modern fertility awareness combined with a symptohormonal method has the potential to provide almost 100% protection against conception without synthetic hormones.
Perfect use: ~98–99%+
Typical use: ~90–98%
If no, thank you for your interest in Solari Wellness. You may exit the form now.
Your personal health information is kept confidential and secure. Any information, laboratory records, or documents submitted through Solari Wellness are used solely for the purpose of providing wellness services and are not shared without your authorization except as required by law.
Please review current service pricing before submitting this form:
https://www.solariwell.com/cost
I acknowledge that I have reviewed the current pricing information for Solari Wellness services and understand that Solari Wellness is a private-pay wellness practice that does not bill insurance. Consultations, laboratory testing, supplements, and wellness recommendations may involve additional out-of-pocket expenses.
I understand that submitting this intake form does not authorize any charges. All recommendations and associated costs will be discussed with me prior to proceeding with care.*