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Make an Appointment

Our Services

TBM (Total Body Modification) - $75 for 55 min.

TBM (Total Body Modification - 40 min) / DPA (Digital Pulse Wave Analyzer - 15 min) - $75 for 55 min.

In order to serve you best at your appointment, please complete the questionnaire below and give a brief description for your visit. * After you submit the questionnaire, you will be taken to a page to access the online appointment scheduler. *

If you are a new client please also print out the New Client Forms listed below. Bring them with you to your appointment or they can be faxed ahead of time to (703) 642-5930 *51.

New Client Forms

You will need Adobe Reader to view the forms. It is a free program and can be downloaded here.

Summary of Health History
General Consent for Treatment
Directions to Evergreen Office
Directions to Home Office
Child Neurotransmitter and Nutrition Questionnaire
Neurotransmitter Assessment Form
Metabolic Assessment Form

Questionnaire

Are you experiencing any of these symptoms? Please check all that apply.

Your Name:

Phone Number:

Acid Reflux or Indigestion	Cold Hands and Feet
Joint Stiffness, Arthritis	Allergies
Dizziness	Constipation or Diarrhea
Asthma or Breathing Problems	Heart Problems
Artery Blockages	High Cholesterol
Susceptible to Colds	Muscle Cramps
Low Energy	Cravings, Addictions
Skin Problems	Anxiety, Depression
Learning Problems	Failing Memory
Vision Problems	Hearing Problems
Insomnia	Overweight
Underweight	Blood Pressure Problems
Blood Sugar Problems	Thin Hair
Poor Quality Nails	Hormone Problems
Irregular Periods	PCOS
Too much hair growth	Menopause Problems
Fatigue

Any organs removed?	Yes No
Silver dental fillings?	Yes No
Many vaccines?	Yes No
Aspartame, diet soda user?	Yes No
Use imitation sweeteners?	Yes No
Eat soy?	Yes No
Smoker?	Yes No

Computer usage (scale of 1 - 10)	12345 678910

Microwave usage (scale of 1 - 10)	12345 678910

Cell Phone usage (scale of 1 - 10)	12345 678910

Reason for visit:


Referred by: