Julian Christopher Cortez, M.Ed., M.A.
Certified Holistic Health
Practitioner
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Your Health History
Forms
Congratulations! You are
about to take the first towards a new,
stronger, healthier you.
Please take the time to fill out and
e-mail the appropriate form from the
selection below. We ask that you please
fill in ALL the fields - you may type
N/A if a certain question/answer field
does not apply to you.
If you are a NEW visitor choose the
right form for you from the Women's,
Men's, or Children's Health History
Form.
If you are a REPEAT visitor, please
take the time to fill out the Revisit
Health History Form and let us know
about your progress.
For any other type of correspondence,
please click HERE
to view our contact information.
Thank you for your interest!
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Women's Health History Form
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Children's
Health History Form
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