Dr. Ria N.D. - QHC II Appointment Forms

Dr.RiaND - Premier Wellness Place for the Whole Family

Queen's Health Center Client Consent Forms &

Educational Forms

Please note all forms and applications are in PDF format, hence it is necessary to print them out and fax them to QHC II prior to your appointment or bring them with you is you are coming to the appointment in person.

Fax #: 215-721-8836

Client Consent Form

Please fill out this form before your 1st appointment

(PDF — 76 KB)

Gallbladder & Liver Flush PDF.

Bellow is a picture of possible object you may eliminate after you do Gallbladder Liver (GBL) flush.

gall stones green

Gallbladder Liver Flush 12 6 2011.pdf (PDF — 167 KB)

Coffee Enema Directions PDF

Coffe enema 11 16 2011.pdf (PDF — 98 KB)

Spirulina Enema Directions PDF

Spirulina enema 7 6 2011.pdf (PDF — 96 KB)

Thyroid Questionnaire

Thyroid Questionaire 7 6 2011.pdf (PDF — 66 KB)

MEAD and BIA Directions

MEAD and BIA directions.doc.pdf (PDF — 81 KB)

Healthy Teeth Protocol

healthy teeth.pdf (PDF — 115 KB)

Metagenics HealthQuestionnaire

Please fill out this form before your 1st appointment

MET427 HAQ Health History.pdf (PDF — 30 KB)

Metagenics First Line Therapy Menu Plan PDF

(PDF — 36 KB)

Apex Child Neurotransmitter & Nutrition Questionnaire (CNNQ) PDF

Apex Child NeuroQuestionnaire (CNNQ) (033011).pdf (PDF — 3 MB)

Apex Health Questionnaire (NTAF) PDF

Apex Health Questionaire (NTAF).pdf (PDF — 490 KB)

Apex Metabolic Assessment Form PDF

Apex Metabolic Assessment Form.pdf (PDF — 690 KB)

How to read your blood test for Thyroid Markers

Thyroid Markers in Blood Test.pdf (PDF — 62 KB)

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