Include your age at the time and all operations, even moles, etc. removed and circumcision.
Pneumonia, mono, tuberculosis., cancer, heart attack, chronic bronchitis, colitis, mumps, measles, chicken pox, etc. If it was more than one year, please indicate the age range. For example: Age 26-30. Treated for cancer.
Please list prescriptions, street drugs, excessive alcohol, and cigarettes you've used in the past and present. If it was more than one year, please indicate the age range. For example: Age 26-30. Smoked a pack of cigarettes a day. Please list vaccination history in that section at the end of this form.
Write your chief complaint(s) below and rate the approximate age of onset. Also indicate the severity: "0" corresponds to no symptoms, and "10" corresponds to the most severely-felt symptoms.
Please list what you can remember about your vaccination history and adverse reactions you may have had.
I understand that Louisa Williams, a naturopathic doctor, has graduated from a federally-accredited four-year naturopathic medical school, Bastyr University, has taken and passed all phases of the national Naturopathic Physicians Licensing Examination (NPLEX), and has passed state exams in order to be licensed as a naturopathic physician in Vermont. (Texas does not yet license ND’s.)
I further understand that Dr. Williams uses along with the standard exam, history-taking, laboratory tests and appropriate radiographic imaging, energetic testing methods including kinesiology and Matrix Reflex Testing (MRT). Like lab tests, which can also give false negative and false positive results, no energetic testing method is 100% accurate. However, MRT and kinesiology can greatly assist in determining a patient’s diagnosis as well as fine-tuning the most appropriate treatments.
Additionally, I am not associated with any government agency, insurance company, pharmaceutical corporation, or other allopathically-oriented groups aimed at eliminating naturopathic medicine. I am simply here as an individual who wants to feel better.
I have read and understood this document.
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