Personalized Patient Wellness Care Name: Date:
Nutritional Support w/ Breakfast w/ Lunch w/ Supper at Bedtime # of Days/Wks/Months Additional Instructions
GastroDigest II® Elite Wellness Care I
Matrix Synergy® Elite Wellness Care II (low purine)
ReGenerZyme® Adrenal 200 Low Purine Foods Diet
VerVita® Therapuetic Grade Essential Oils
Sore to Soar®

By mouth in food/juice


x per day for days weeks months  

Rub on


(Check areas) Forehead Back of neck Base of skull throat chest spine palms of hands
wrists back of knees arch of left foot arch of right foot other   

Bath or Footbath


(Check one) Soak 30 minutes.
Fill tub with warm water and add: # of (drops ml bottles / Check one) essential oil lbs Epsom Salt
Total number of baths Take 1 bath every day(s) week(s) month(s) (Check one) until finished  
Other:
Natural Balancing Cream
RejuvAllure® Skin Cream
Cork Heel Lifts (Check size)
CRA-flex® Orthotics (Check one) 		Topically Location:
Topically Location:
C1 C2 C3 C4 C5 Place in (check one) RIGHT LEFT BOTH ...heel(s) of shoes
scan and order reorder
Structures
Spine - T3, C7, Atlas Print on Patent's Copy Do Not Print on Patient's Copy