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Elina Stanley is certified Holistic Nutrition Consultant. 
Also currently working on her Master's Degree in Clinical Nutrition at Kingdom College of Natural Health. Ms.Stanley consults in the Washington DC area with individual clients about nutritional needs of children, women and men of any age and any health point. As well as educating about how to improve your life style towards optimum health through the right nutrition, stress management, exercise program and how to create a healthy environment for yourself and your family.

Healthy living has been Ms. Stanley’s passion and a way of life that translates into every aspect of her life. Formerly a lawyer in the Republic of Moldova, after moving to the United States she’s instead pursued her passion and desire to learn and share the knowledge of Healthy Nutrition by consulting others of the positive effects of best nutritional practice as well as maintaining a healthy mind and body.
  


 

Information Form:

Name
Address
Apt#
City
State
Home Phone
Cell#
E-mail address
Reffered By
Occupation
Employer
Date of Birth
Age
Sex
Height
Weight
Overall Health
Other
Indicate the most immediate concerns for you
Previous treatment for this complaint
Other complaints or problems
Current medications/drugs being taken
Nutritional supplements/ vitamins you are taking
Do you smoke, drink coffee or alcohol? (if yes indicate how much)
Cigarettes
Coffee
Alcohol
List any major illnesses (with approx. date)
Marital Status:
Name of Spouse
Describe health of spouse
#of children
Any family history of serious illnesses:
List all allergies and sensitivities
Do you make time for rest/relaxation during the day or before bed?
How do you relax?

Diet
Number of meals eaten per day
List the primary foods included in your diet
List the foods excluded from your diet
List any foods you crave
Are you satisfied with your diet?
If not, why not?
How open are you to change your lifestyle habits to accommodate your concerns?