[vc_row full_width=”” enable_parallax=”1″ content_full_width=”1″ font_color=”#ffffff”][vc_column][vc_single_image image=”3099″ img_size=”1920×325″ alignment=”center” css=”.vc_custom_1441692234493{padding-bottom: 45px !important;}”][/vc_column][/vc_row][vc_row full_width=””][vc_column width=”¾″][vc_empty_space height=”5px”][vc_custom_heading text=”Important Health Forms” font_container=”tag:h2|font_size:36|text_align:left|color:%237cb355″ google_fonts=”font_family:Lato%3A100%2C100italic%2C300%2C300italic%2Cregular%2Citalic%2C700%2C700italic%2C900%2C900italic|font_style:400%20regular%3A400%3Anormal”][vc_empty_space height=”15px”][vc_separator color=”custom” align=”align_left” border_width=”3″ accent_color=”#9dc680″][vc_empty_space height=”15px”][vc_column_text]Simply complete the form below by filling-in the requested information. This data helps me better understand you, your body and your behaviors. As a certified Holistic Health Coach I am bound by the HIPPA privacy rule and you can rest assured that all information provided will remain strictly confidential. The information I collect is never provided to any third parties, nor is it used for anything other than discussion topics during our sessions.[/vc_column_text][vc_empty_space height=”15px”][vc_separator color=”custom” border_width=”2″ accent_color=”#9ca3b3″][vc_empty_space height=”15px”][vc_row_inner][vc_column_inner width=”⅓″][vc_single_image image=”3110″ img_size=”full” alignment=”center”][vc_custom_heading text=”Revisit Form” font_container=”tag:h4|font_size:18px|text_align:center|color:%234d4c84|line_height:1″ google_fonts=”font_family:Lato%3A100%2C100italic%2C300%2C300italic%2Cregular%2Citalic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_empty_space height=”25px”][vc_btn title=”ONLINE FORM” style=”outline-custom” outline_custom_color=”#7cb355″ outline_custom_hover_background=”#9dc680″ outline_custom_hover_text=”#ffffff” shape=”square” align=”center” i_align=”right” i_icon_fontawesome=”fa fa-arrow-circle-o-right” link=”url:http%3A%2F%2Fdebraklein.kinsta.cloud%2Frevisit-form%2F||” add_icon=”true”][/vc_column_inner][vc_column_inner width=”⅓″][vc_single_image image=”3108″ img_size=”full” alignment=”center”][vc_custom_heading text=”Medical History, Female” font_container=”tag:h4|font_size:18px|text_align:center|color:%234d4c84|line_height:1″ google_fonts=”font_family:Lato%3A100%2C100italic%2C300%2C300italic%2Cregular%2Citalic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_empty_space height=”25px”][vc_btn title=”ONLINE FORM” style=”outline-custom” outline_custom_color=”#7cb355″ outline_custom_hover_background=”#9dc680″ outline_custom_hover_text=”#ffffff” shape=”square” align=”center” i_align=”right” i_icon_fontawesome=”fa fa-arrow-circle-o-right” link=”url:http%3A%2F%2Fdebraklein.kinsta.cloud%2Fwomens-health-history%2F||” add_icon=”true”][/vc_column_inner][vc_column_inner width=”⅓″][vc_single_image image=”3107″ img_size=”full” alignment=”center”][vc_custom_heading text=”Medical History, Male” font_container=”tag:h4|font_size:18px|text_align:center|color:%234d4c84|line_height:1″ google_fonts=”font_family:Lato%3A100%2C100italic%2C300%2C300italic%2Cregular%2Citalic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20regular%3A700%3Anormal”][vc_empty_space height=”25px”][vc_btn title=”ONLINE FORM” style=”outline-custom” outline_custom_color=”#7cb355″ outline_custom_hover_background=”#9dc680″ outline_custom_hover_text=”#ffffff” shape=”square” align=”center” i_align=”right” i_icon_fontawesome=”fa fa-arrow-circle-o-right” link=”url:http%3A%2F%2Fdebraklein.kinsta.cloud%2Fmens-health-history%2F||” add_icon=”true”][/vc_column_inner][/vc_row_inner][/vc_column][vc_column width=”¼″][vc_widget_sidebar sidebar_id=”cshero-blog-sidebar”][/vc_column][/vc_row][vc_row][vc_column][vc_empty_space height=”85px”][/vc_column][/vc_row]
