New Client Forms

Thank you for your interest in Long Term Solutions, LLC.   We have been in business since 2010 assisting clients on their journey to long term health. During those years we have kept up to date in the most cutting edge clinical assessments and nutritional products available.  Our clinical assessments involved both subjective and objective forms of testing. As we continue to grow as a clinic we have added a host of other  assessments to better understand the underlying cause of the bodies dysfunction.   Some common types of assessment we use are Nutrition Response Testing SM, Bio Energetic Testing, and other forms of Functional Testing,

The overwhelming needs of our community have lead us to take a temporary pause  in accepting new clients. We are currently working on updating our systems for better client flow, interviewing other like minded health care professionals to establish more collaborative relationships, researching other areas of clinical interest, and looking for new office space.  Please accept our appologies for temporarily not being able to meet your current nutritional needs.  We would be more that happy to have you send us an email to discuss your unique situation.  We will call you back and either help to find you a local practitioner or put you on our Wait List.       We look forward to accepting to New Clients again soon.  




We look forward to the opportunity to evaluate your situation and partner with your on your healing journey. The first (2) visits consist of Evaluation and Report of Findings.   Evaluation includes: Consultation, Bio-Energetic Assessment, Nutrition Response Testing SM  Exam and other Clinical Data Collection. Report of Findings visit reviews the results of the Evaluation and  "Natural Health Improvement Plan". Both appointments are scheduled for approximately two hours each and on separate days. During these visit we welcome any questions or concerns you may have and will do everything in our power to get those addressed.

In preparation for the Evaluation visit, please Print and Complete the Forms below.  Once the Forms are returned to the office, we will schedule your (2) appointments and collect payment in Full.  Preparation for your appointment takes several hours and we find it more beneficial to start this process prior to your Evaluation.   The practitioner will review the Forms and research any pertinent data specific to your situation .  She also may email you with some follow up questions.  The Evaluation time can then be spent intentionally listening to your concerns and gathering various assessment data. 

PLEASE NOTE: Every question on these forms is important to your evaluation process, so please answer them accordingly. No section should be left blank. Not applicable (NA) should be used when no information is available.

Authorization Form 

New Client Information (Adult, Pediatric, or Pediatric Short Form) 

Bristol Stool Chart (Review)

Food Guidelines (Review) 

Food Log:  Review the Guidelines first, then complete the log as per directions.  Start completing your food log NOW, as it is a 3 day Food Log and needs to be included along with the other paperwork. 

Phytonutrient Spectrum Foods:  With a Red Pen, circle the foods that you currently eat.  With a Blue Pen, circle the foods that you are willing to try.

Symptom Survey- Complete the form in Black Ink, then write the number corresponding to your symptoms (mild, moderate, or severe )in the appropriate boxes in RED.

What Fills me up and What Drains me Handout (print and complete)

Evaluation $250.00 

 What else to include with your intial paperwork?

  • All  medications and supplements- whether they are taken every day or on a as needed basis. If this is a Clinic Visit, then bring ALL of them with you. If this is a Remote Visit, then you will need to take Clear Photos of the prescription label on your medications, and for supplements/over the counter medications you will need to take a PHOTO of the front AND the back of the bottles.
  • Copies or Scans of the results of any recent blood work, or other diagnostic testing (MRI, CT Scan, Xray, etc.).  They will be returned at the Report of Findings Visit.

We look forward seeing you soon.



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