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iHEALTHe Institute Health Info Form

 

Welcome to the iHEALTHe Institute! We want to reassure you that all the information that you provide in this form is PRIVATE and CONFIDENTIAL. This form is reviewed by a healthcare professional on our team. Once you complete the health info form, you will receive an email back from the healthcare team giving you the go ahead to begin the program. If further consultation is required, you will be notified. 
 
Personal Information:
 
 
 
 
 
 
 
Health Questions:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Exercise and Stress:
 
 
Liquid Intake:
 
 
Your Heart and Circulation:
 
 
Your Limbs and Joints:
 
 
Your Temperature and Perspiration:
 
 
 
 
 
Further Health Questions:
 
 
Member Declaration:
Consent and Release of Liability: