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    iHeal Complete Lifestyle Assessment


    The completion of this Lifestyle Assessment takes approximately 30 minutes. Data inserted cannot be saved so we recommend that once the filling of the assessment has begun, it should be completed and submitted by pressing the "Submit Assessment" button below.

    Disclaimer

    ​iHeal Representatives are NOT doctors, nurses, dieticians, or professional medical care providers unless they happen to also have undergone licensing in those fields. The information shared by iHeal Representatives is provided for general informational purposes only and is not intended to replace medical advice or treatment. iHeal Representatives have no expertise in diagnosing, examining or treating medical conditions, nor can they accurately determine the specific effect of any lifestyle habit on medical conditions.

    Agreement

    I agree that I will take no action or inaction based solely on a product or suggestions made by the iHeal Representative. I understand that lifestyle changes and/or questions about symptoms, medications, exercise techniques, and my health in general, should be addressed directly to a licensed health care professional. By completing the assessment and participating in the iHeal consultation, I assume all risk of injury, and agree to release and discharge the iHeal company and the iHeal Representatives from any and all claims or causes of action, known or unknown, arising from the interaction with the iHeal representative.

    Confidentiality

    Once completed, the information contained in this form will be treated with utmost confidentiality. Information will not be released to a third party without your written consent.  ​​

    CURRENT HEALTH STATUS














    NUTRITION
















    EXERCISE


    If you exercise...



    WATER






    SUNLIGHT






    TEMPERANCE


















    AIR






    REST






    TRUST








    If you are currently in contact with an iHeal Representative, please enter their name below.

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    We thank you for filling the application. By submitting this application, you certify that the answers given are true and complete to the best of your knowledge and authorize an iHeal Representative to contact you in regards to your condition with recommendations.

    PLEASE REMEMBER TO CLICK ON THE "SUBMIT ASSESSMENT" BUTTON BELOW
SUBMIT ASSESSMENT
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