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Welcome to Heart Rock Healing!

Please complete this form to help us understand your health concerns. We offer a complimentary 15–20 minute discovery consultation to provide simple recommendations. For more complex issues requiring detailed support, we offer personalized healing plans. Details will be discussed during your discovery consult.

Start my Journey
Assessment

Assessment

Name

Phone

Best time to reach you by phone

Height

Weight

Gender

More about You

What are you looking for help with?

Did you see a product on the website or Facebook page you are interested in or curious about?

Do you have any allergies?

List of all medications you are currently taking. Be sure to include prescription drugs, over-the-counter medications you have purchased yourself, herbs, cannabis/hemp/thc, vitamins and supplements.

How often do you exercise?

Do you sleep well? How many hours a night?

Do you smoke cigarettes?

Are you pregnant or nursing?

Is there anything else affecting your health right now that you would like me to know about?

Any other questions or concerns?

*The information I provide is not intended to be a substitute for medical treatment but instead to help support or bolster what concerns arise. Please consult your medical care provider before using herbal medicine, particularly if you have a known medical condition or if you are pregnant or nursing. As with conventional medicine, herbal medicine is vast and complex, and must be used responsibly. Some herbs are contraindicated with certain pharmaceutical drugs, so I encourage you to do your own research.