Chrysalis Nutrition & Health Nutrition Consultation Forms

Thank you for enlisting my help for your nutrition and health needs!

On this page you will get started with preliminary required information so you can begin nutrition consultations.

Please choose from one of the 2 options below:

OPTION #1: If you purchased a Nutrition Starter Package of 3 sessions, the information you will need to provide me so that I can provide comprehensive care is listed below.  Please print out and complete these 4 forms when you have time to devote to them, explaining your current situation and the goals you would like to achieve. Please be as thorough as possible. I know that I am asking a lot of you. The more you tell me, the better I can help you. This is not the time to rush through them to finish. For your best care, I need to have these forms returned to me before we can set up an appointment.

Client Agreement and Release

Client Intake Form

Client Diet Diary

Client Food and Personal Observations

Please either scan and email the completed information to me at  service@powerofprobiotics.com (email is not secured) or print them out and mail them to me at:

Chrysalis Nutrition and Health, LLC

2221 E. Arapahoe Road, #2083

Centennial, CO 80122

Please email me at service@powerofprobiotics.com to let me know the forms are on their way and contact me with any questions. Thank you!!!

OPTION #2: If you purchased the food pantry makeover or the grocery store guidance, there is only one form that needs to be completed and returned to me so we can set up an appointment. This form is listed below.

Client Agreement and Release

Please either scan and email the completed information to me at service@powerofprobiotics.com (email is not secured) or print them out and mail them to me at:

Chrysalis Nutrition and Health, LLC

2221 E. Arapahoe Road, #2083

Centennial, CO 80122

Please email me at service@powerofprobiotics.com to let me know the forms are on their way and contact me with any questions. Thank you!!!


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Disclaimer: The information contained in this site is educational in nature and is not intended as diagnosis, treatment, prescription or cure for any physical or mental disease, nor is it intended as a substitute for regular medical care. Consult with your doctor regarding any health or medical concerns you may have.

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