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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

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Nutritional Blood Chemistry Analysis (NBCA) Questionnaires

     When ordering the Nutritional Blood Chemistry Analysis (NBCA) separately from the Clinical and Sports Nutrition Comprehensive Analysis, you will order your Laboratory Testing and complete the following questionnaires.
     The questionnaires with one asterisk (*) are to be completed and sent with your first order for the Nutritional Blood Chemistry Analysis (NBCA). The questionnaire with two asterisks (**), the Health Appraisal Comprehensive, is included FREE with your first two orders for the Nutritional Blood Chemistry Analysis (NBCA).
     Therefore, after ordering your first two Nutritional Blood Chemistry Analysis, you will need to click only on Laboratory Testing when re-ordering the Nutritional Blood Chemistry Analysis for re-evaluations.

Laboratory Testing
Health Appraisal Comprehensive (HAC) Questionnaire** - (Send with first two NBCA orders only)

Client Information* - (Send with first order only)
Informed Consent* - (Send with first order only)