Wholistic Health Center, PLLC

Patient Forms
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Patient Forms

Before You Visit

Please print and fill out the following forms before your visit.

New Patient Information Form



 Natural remedies:

Super Foods for a Happy Heart:

Leafy Green vegetables


Whole Grains


Fatty Fish and Fish Oil



Dark Chocolate





Olive Oil


Green Tea



What are Electromagnetic Fields?

Electromagnetic fields (EMF's) are areas of energy that cannot be seen.  It is sometimes referred to as radiation.  Objects and beings all have an electrical current.  EMF's are emitted from natural sources and man-made sources.

Where do they come from?

  • Cellphones
  • Computers
  • TV's
  • Microwave ovens
  • WiFi routers

What are the Health Risks

Exposure to EMF's is not a new phenomenon.  EMF's have been around forever, as the Earth has its own Electromagnetic field.  However, humans today are being exposed to an unprecedented amount of radiation from man made items and technology.  Strong artificial EMF's can impose on the body's biological functions.

Potential health risks include:

  • Insomnia
  • Hormonal disruption
  • Brain fog
  • Depression
  • Mitochondiral dsyfunction
  • Cell membrane deterioration

What can you do?

  • Limit technology in the house
  • Turn your cellphone on airplane mode when not in use
  • Keep your cellphone away from children
  • Do not sleep with your cell phone
Affiliate Links & Discounts
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One by one, we are leading a movement to a future where all beauty is clean beauty. We are powered by people, and our collective mission is to get safer products into the hands of everyone. Formulate, advocate, & educate—that’s our motto for creating clean beauty products that truly perform while holding ourselves to unparalleled standards of safety.  Why? It’s really this simple: beauty should be good for you. We take safety seriously. Over 2,800 ingredients are never used in our formulations—we call this The Never List™—and we go above and beyond to screen every ingredient against our high standards in pursuit of clean beauty.  While all of our ingredients are sourced with a higher standard of safety and quality in mind, it is well recognized — and accepted by regulatory authorities around the world — that incidental, trace levels of a chemical may inadvertently be introduced in a cosmetic product due to the complexities of the supply chain and manufacturing process. At Beautycounter, we work incredibly hard to minimize — but unfortunately, can’t eliminate — the potential that a product may contain trace levels of a chemical from The Never List™.  

Queen of the Thrones offers an easy way to engage colon cleansing, lymphatic drainage and liver detox so that you can support hormone balance.  Castor oil liver packs are an essential tool to use for your healthcare.  Queen of the Thrones® is the #1 practitioner-recommended original less-mess & reusable Organic Castor Oil Pack for Liver Kit designed by a naturopathic doctor to support liver detox, lymphatic drainage and colon cleansing.
  • Hormone balance 
  • Deep sleep 
  • Constipation and bloating relief
  • Inflammation and leaky gut 
  • Less stress and anxiety
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Happy Life Greens

Happy Life Greens is a soil free, GMO free, pesticide free, fertilizer free farm, free from toxic plastic grow trays used in conventional micro green production and free from heavy metals, chlorine and bacterial contaminants in the water.


The Weston A. Price Foundation (WAPF) is your source for accurate information on nutrition and health, always aiming to provide the scientific validation of traditional foodways. People seeking health today often condemn certain food groups — such as grains, dairy foods, meat, salt, fat, sauces, sweets and nightshade vegetables — but the Wise Traditions Diet is inclusive, not exclusive.


IFNH is a non-profit educational organization reaching out to healthcare professionals. The focus of IFNH is on whole food nutritional research spanning over 140 years from many renowned leaders in the fields of medicine, biochemistry and dentistry.


For over thirty years, Selene River Press has been the leader in nutrition education. Our goal is to help readers get beyond fads, miracle diets, and other misinformation with resources rooted in nutrition’s original principles, as revealed by the field’s first researchers.


Nancy Appleton PhD started writing and lecturing about health in the late 1970s as a reaction to her own poor health. Her discoveries about sugar and other common diet mistakes led to her first book Lick the Sugar Habit, which is still chugging along as a 25-year bestseller.   


Francis M. Pottenger, Jr., MD, dedicated his professional life to understanding the role of nutrition in the prevention of chronic illnesses and physical degeneration. Dr. Pottenger’s studies consistently demonstrated the direct relationship between a healthy diet and vital living.