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Professional Consultants

DONNA F. SMITH, C.C.N., C.N.
Licensed, Board Certified
Clinical Nutritionist

WILLIAM H. BRELAND, P.T., S.C.S.
Physical Therapist
Board Certified Sports Specialist

ROBERT J. WOLFF, D.C.
Chiropractor

T. ROGER HUMPHREY, M.D.
Physician

Advanced Clinical Nutrition
Wichita Falls, Tx
76309-3119
Office (940) 761-4045
Fax (940) 761-2881
E-Mail: wsnqas@aol.com

The information and services provided are for nutritional support, and not for the treatment of any medical condition or disease. By using this web site, you understand and abide by this disclaimer.

Copyright 1999
Donna F. Smith

Women Sports Nutrition Logo
Laboratory Requisition
Date of Laboratory Testing:
Patient's Name:



Dear Dr. :

     Your patient has requested a clinical nutrition analysis of the following blood tests and has given your name as the preferred doctor. Clinical nutrition blood analysis is provided through Advanced Clinical Nutrition, Wichita Falls, Texas, for the purpose of designing a clinical and sports nutrition wellness program.

     Thank you in advance for ordering the following tests for your patient:

Blood Chemistry - 24
CBC with Differential
Lipid Profile (Total Cholesterol, Triglycerides, HDL, LDL, HDL/Chol. Ratio)
Thyroid Profile (T-3, T-4, T-7, and TSH)
Iron and Magnesium, if not included in Chem-24

     We appreciate your assistance in your patient's overall health care by providing this service, and the expeditious mailing of the above lab reports to the address below.

Warm Regards,

Donna F. Smith's Signature

DONNA F. SMITH, C.N., C.C.N.
Licensed, Board Certified Clinical Nutritionist


cc: Advanced Clinical Nutrition for Women's Sports Nutrition
1911 Tilden Street, Wichita Falls, Tx 76309-3119
Office (940) 761-4045 Fax (940) 761-2881




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