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STOP Taking The Wrong Vitamins! - It's Best To Test, Before You Buy..Vitamins!

 
 
INQUIRY QUESTIONNAIRE
(Scroll Down Web Page for Questionnaire form)
    
and to Schedule

   
FREE INQUIRY TELEPHONE CONSULTATION



To Prepare for Telephone Consultation with Dr. Smith,
To  Inquire About and To Order
 
Clinical Nutrition Testing....


  • Please Read All the Information On This Web page.
  • Complete each question in the Inquiry Questionnaire below and then click the 'Send" button.
  • Read and following the instructions in "How To Prepare For Your Inquiry Telephone Consultation with Dr. Smith" and the Frequently Asked Questions At The Inquiry Consultation PDF Document, both of which are located after the Inquiry Questionnaire.
  • Attention Inquirers - please open and read the PDF File to the right before scheduling appointment with Dr. Smith.
  • After the above, you are ready to schedule your Free No-Obligation Inquiry Telephone Consultation With Dr. Smith by Calling the number below or you may wait for our office to call you, if you have provided the Best Days and Times (C.S.T.) to call you on the Inquiry Questionnaire.
  • Please allow 90 minutes for the Inquiry Consultation.  More time may be required, depending upon the number of questions asked OR less time, when the Inquirer and the Head of Household have read and completed the instructions on this web page and their PDF documents.

CONTACT INFORMATION


PURPOSE OF INQUIRY QUESTIONNAIRE

Reviewing the Patient's Personal Information on the Inquiry Questionnaire, before the Inquiry Telephone Consultation, will give Dr. Smith the opportunity to prepare an Initial Nutritional Assessment and Financial Plan so that she may recommend the specific services that best suits the patient's needs and will save time at the Inquiry Telephone Consultation. 

If the Inquirer is not the Head of Household, please read the "Attention Inquirers" PDF Document below and schedule the Inquiry Telephone Consultation with Dr. Smith when the Head of Household can be present with the Inquirer.  Note:  This includes the Patient, too, if the Patient is not the Inquirer  or a child under 12 years old.

Document
ATTENTION INQUIRERS
                                                                        __________________________________________________   

CONFIDENTIALITY
Information on the Inquiry Questionnaire is confidential and used only by Dr. Smith and her staff for the purpose of the Inquiry Consultation and providing the services of Advanced Clinical Nutrition.  You may click on the PDF Document below for our complete Confidentiality / Privacy Notice.  In the event, our clinical nutrition services are not engaged at this time, no future contact will be made to the Inquirer or Patient, if not the same, using the information on the Inquiry Questionnaire, unless requested by the Inquirer or Patient.  We respect your privacy.  

Note:  If clinical nutrition therapy is not started at this time, we highly recommend that you read he "W.F. Supplements" web page and order whole food supplements for health maintenance purposes as needed. T
aking synthetic and isolated vitamin and mineral supplements, which are the primary supplements sold to the public today, suppresses symptoms and manipulates your biochemistry, which in time leads to a myriad of new health challenges.  Only Whole Food  (W.F.) Supplements heal and maintain health.  The "W. F. Supplements" web page is located in the Table of Contents under the "Inquiry Questionnaire."

Dr. Donna F. Smith
(940) 761-4045

Services@AdvancedClinicalNutrition.com

Thank you.

Document
Privacy Notice
 
  
INQUIRY QUESTIONNAIRE

Provide Patient Information, Unless Otherwise Requested.

 
DATE COMPLETED INQUIRY QUESTIONNAIRE:
PATIENT'S FIRST & LAST NAME:
NOT PATIENT? YOUR FIRST/LAST NAME & RELATIONSHIP?
AGE:
BIRTHDATE:
E-MAIL ADDRESS:
WHO OR WHAT REFERRED YOU? IF INTERNET, PLEASE LIST KEY WORDS.
YOUR TIME ZONE? (NOTE: APPTS ARE SET IN C.S.T.)
BEST DAYS & TIMES (C.S.T.) TO CALL YOU?
DAYTIME PHONE NUMBER:() -
EVENING PHONE NUMBER:() -
FAX NUMBER:() -
MAILING ADDRESS:
CITY, STATE, ZIPCODE:
COUNTRY:
#1 HEALTH CONCERN?
#2 HEALTH CONCERN?
#3 HEALTH CONCERN?
#4 HEALTH CONCERN?
#5 HEALTH CONCERN?
OCCUPATION:
EXPOSED TO CHEMICALS OR METALS AT WORK OR HOME? IF YES, LIST.
DID YOU READ ALL "WHY TEST?" WEBPAGES? YES OR NO.
DID YOU READ ALL "OUR SERVICES" WEBPAGES? YES OR NO.
DID YOU READ THE "ORDERING W.F. SUPPLEMENTS" WEBPAGE? YES OR NO.
IF YOU ANSWERED NO TO READING WEBPAGES, PLEASE PUT EITHER "I WILL OR WILL NOT READ BEFORE APPT."
DID YOU SUBSCRIBE TO DR. SMITH'S NEWSLETTER? YES OR NO.
IF YOU HAVE NOT SUBSCRIBED, DO YOU PLAN TO? YES OR NO.
INTERESTED IN IMPROVING CONCERNS, OVERALL HEALTH, OR BOTH?
DO YOU HAVE THE FINAL WORD REGARDING FINANCES? (YES OR NO) PLEASE ANSWER ACCURATELY. IF ANSWER IS NO, HEAD OF HOUSEHOLD MUST BE PRESENT AT INQUIRY CONSULTATION.
FIRST/LAST NAME OF HEAD OF HOUSEHOLD:
IF YOU WERE REFERRED BY A PERSON WHO IS NOT A CLIENT, PLEASE PROVIDE THEIR ADDRESS SO WE MAY SEND THEM A THANK YOU CARD.
IS THERE ANYTHING ELSE YOU WANT TO COMMUNICATE TO DR. SMITH?
 

WEBPAGE READING LIST

and

HOW TO PREPARE FOR YOUR INQUIRY TELEPHONE CONSULTATION

WITH DR. SMITH

              It is important to Dr. Smith that you make an "informed" decision about starting Clinical Nutrition Therapy.  Therefore, to help you receive the factual information you need to make this decision, Dr. Smith has provided links below to specific webpages for you to read before your Inquiry Telephone Consultation appointment with her. 

            Then, having read these webpage before this appointment, you and Dr. Smith can utilize your consultation time to discuss the specific services you need (and their fees) to help you improve your current health challenges, as well as attain other health goals you may have.  Also, reading these webpages will help reduce the total amount of time needed for your Inquiry Consultation.

Therefore, once you have completed and sent your Inquiry Questionnaire, please read the following webpages, in the order presented, so you may build a sequential foundation of knowledge, if you have not already read these webpages when initially browsing our website.   .

 WEBPAGE READING LIST

  1. "Why Test?" -  this webpage and its pop-out webpages help you understand…: 
    1. The difference between a scientific Evaluation and a scientific Test, as well as why testing is important before taking any nutritional supplement.  Yes, even those you have been taking that were purchased based on “guessing” not “testing.”
    2. How Clinical Nutrition saves and pays you now and in the future, and
    3. Provides overview of what poor health is costing you.
  2. "Lab Tests - Insurance?" –
    1. The most frequently ordered Lab Tests are listed on this web page with a link to their individual web pages, where you can view actual copies of Laboratory Reports. 
    2. Questions about insurance coverage for our services are also answered on this web page.
  3. "Our Services"  -
    1. In addition to what you have learned about Lab Testing in #2 above, this webpage and its pop-out webpages provides information on all of our other Clinical Nutrition Services.  
    2. These webpages explain how we provide our services to local and long-distance clientele.
    3. Note:  On the Nutritional Analysis pop-out webpage, be sure to read the PDF article on the “Difference between a Clinical Nutrition and Medical Analysis (or interpretation) of Laboratory Reports.”  Reading this will help you understand why a Clinical Nutrition Analysis of Lab Reports identify the causes of your symptoms when all medical tests are normal, i.e., when your physician says there are no medical causes for your symptoms.  Though a patientThis is very good news or as a number of new clients have reported to us, they were told,
  4.  "Health Store Online" –  
    1. This is an important web page for your family and friends who are not currently receiving Clinical Nutrition Therapy and you, should you choose not to start therapy, at this time, i.e., after your Inquiry Consultation with Dr. Smith.   
    2. In other words, this webpage provides information on the “Health Maintenance Services” we provide to the public that does not require Clinical Nutrition Testing, Therapy or Therapeutic Consultations.

Please proceed to the instructions below regarding “Scheduling Inquiry Consultation,” so that you will know what to do after you have read the above webpages.   If you are a Female Inquirer, also, please read the last section on this webpage titled, “Attention Female Inquirers,” before scheduling your Inquiry Consultation.


SCHEDULING INQUIRY CONSULTATION

To schedule, choose the options that are best for you below:

  1. You may call our office at (940) 761-4045 to schedule your Inquiry Consultation after completing and sending your Inquiry Questionnaire, scheduling this appointment for a day and time that allows you to complete the Webpage Reading List above. OR
  1. Wait for Dr. Smith to call you during the next available time in her schedule that aligns with what you indicated on your Inquiry Questionnaire regarding the "Best Days & C.S.T.  Times To Call You?"
Important Note:  If you have sent your completed Inquiry Questionnaire and finished the Webpage Reading List, and then call to schedule your Inquiry Consultation, if Dr. Smith is available, she will take your call and provide your Inquiry Consultation at that time.   If she is not available, her assistant will schedule the Inquiry Telephone Consultation appointment for the first available time that works for your schedule and Dr. Smith’s.   However, if you are not the Head of Household or must consult with your partner before making the financial decision to start Clinical Nutrition, an appointment for the Inquiry Consultation must be scheduled when both you and your partner can be present.  Thank you in advance for your commitment to improve your health in the way God designed it to heal, i.e., through whole food nutrients dispensed based on a scientific Clinical Nutrition Analysis of your Laboratory Reports.

 

Disclaimer/Copyright

Information provided in this website is for nutritional educational purposes only and not for the diagnosis, or treatment of any medical condition, disorder or disease.
Copyright 2004  Dr. Donna F. Smith  --  Last Website Update:  OCT 31, 2017  11:45 AM CST

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