ADVANCED CLINICAL NUTRITION - Dr. D. Smith (940) 761-4045 Welcome to our Client website. It is a Secure Site (Read Footnote). For our Mobile Phone & User Friendly Visitor website go to AdvancedClinicalNutrition.Com - Over 90% Client Health Success Record; Clients in 37 U.S. States and 7 International Countries!!!
Want Results? Stop Taking The Wrong Vitamins! Best To Test Before You Buy!
FORMS AND QUESTIONNAIRES - ALL
Before Reading This Page, Please Read the "Forms & Questionnaires" web page.
This web page lists all General Client Forms. If the form you seek is not listed below, you will find the form on either the "PEP Binder Documents," "Specialized Program" or "PEP Lifestyle Program" Web page, whichever applies.
AXILLARY TEMPERATURE TEST (ATT) - ARTICLE & CHART Basal Metabolism Testing for Hypothyroid Function Analysis You may print the entire article or only the last page. The last page is the Axillary Temperature Chart. Please read the entire article for temperature testing instructions and how to record your temperature on this chart.
Provdes the normal readings according to your age. These numbers represent the maximum numbers for healthy readings, which may differ from medical normal readings per age.
Find the numbers for Blood Pressure (Systolic and Diastolic) and Pulse for your current age and transfer this information where indicated on your printed copy of the "Blood Pressure and Pulse Record." Remember to change these numbers when your age changes each decade.
Blood Pressure and Pulse Record: This form is used to record blood pressure and pulse reading when you are currently receiving Clinical Nutrition Therapy to assist the body in normalizing blood pressure, when specially requested by Dr. Smith, and for preventative purposes. Dr. Smith will verbally recommend or include on your Therapeutic Supplement Program of Care (POC) document how often to take your blood pressure and pulse. Other instructions are included on this record form.
Open PDF Icon Documents in the right column, which apply to you:
If this is your first Client Communicator to print for recording on and
You have less than 21 symptoms, print "CC - Page 1 - Symptoms 1-21."
If you have more than 21 symptoms, print "CC - Page 1 - Symptoms 1-21" and "CC - Page
2 - Symptoms 21-42."
If you have completely each column in your current Client Communicator, print the PDF document titled, "Side 1 - No Numbers" below, Then hand-write in the first column on Side 1 the next number that follows according to the last number for the row on the Client Communicator you just completed. Where indicated in the upper-right corner, hand-write the page number on Side 1.
For example if you have completed "CC - Page 1 - Symptoms 1-21" because you had 21 or less symptoms, then this would be page 2.
However, if you had 42 or less symptoms, then this would be page 3.
Print "CC - Side 2 for Page 1 & 2 and Side 1" on the back of all of the above.
If you are printing this because your previous Client Communicator form is full, please transfer symptoms from your previous CC to your newly printed CC form, unless you have a zero (0) score for three months in a row.
Update the Client Communicator before each Progress Reporting (PR) Consultation and send to Dr. Smith by fax, email or U.S. so that it arrives at least 48-hour before PR appointment.
Update the CC form before each Report of Findings Consultations, unless it has already been updated at a Progress Reporting Consultation scheduled in the same month.
Read instructions on Page 2 and include updates as they occur.
HAVE 43 OR MORE SYMPTOMS FOR THE CLIENT COMMUNICATOR? Use the "CC-PAGE 1 - NO NUMBERS" - PDF DOCUMENT AT RIGHT
After completing CC - Page 1 and 2 above, print PDF document for "CC - Side 1 - No Numbers if you have more than 42 Symptoms to record on the Client Communicator. This form has no numbers in the left column so you can insert the numbers, accordingly. Then on the back of each additional CC-Page 1 - No Numbers" form, print the above "CC - Side 2 for Page 1" - the same Side 2 page you printed on the back of CC - Page 1 (#1 - 21) and CC - Page 2 (#22 to 42).
CLIENT INFORMATION FORM (6-Pages) Update to provide new contact information for client, physician, chiropractor and/or other professionals or any other information on this form.
If you did not complete this form with your initial Health and Symptom Questionnaires when you first became a client, please complete every question that applies to you as instructed on this form. For Re-Evaluations, you may complete only the questions that need to be updated since the initial completion of this form.
Please complete this on each symptom or health challenge, or the ones you are most inspired to report on, that has benefited from our clinical nutrition therapeutic services... so that:
we may have narrative feedback about your health improvement for our records.
we may share your success with others so they may be encouraged that Clinical Nutrition and Naturopathic Therapy Really Works!!! Remember when you first became a client and was unsure about clinical nutrition therapy. Your success story can be that deciding factor to give someone else the confidence to give clinical nutrition a chance to prove to them, too, that it works.
URINALYSIS TEST STRIPS - RECORD (1-Pages) Record monthly urine test results on this document and submit a copy of the updated record the day before each Progress Reporting (PR) and Report of Finding (RF) Consultation Appointment.
Print this log and keep it in a safe place. As you receive services that include passcodes to open other web pages for educational information and forms, write them in the appropriate place on this log.
These passcodes will be included on your invoice provided for payment of these services. Otherwise, they may be communicated verbally at the consultation when education is presented or sent in an email.
In case we have updated the website, but have not yet posted an updated Webpage Passcode Log, keep the following in mind. Though the order of the webpages on our website may change and the webpage mumber that precedes the Title of the Webpage may change, the title of the webpages rarely change, so look for titles first. If you have any challenges with this call and ask that an updated log be emailed to you.
Disclaimer: Information provided in website for nutritional educational purposes only and not for diagnosis or treatment of any medical condition, disorder or disease
.
MAILING ADDRESS: P. O. BOX 4652, WICHITA FALLS, TX 76308-0652
Copyright 2004 Dr. Donna F. Smith -- .NET 8/22/18
A Word from Dr. Smith regarding this Secure Website. "I have had this website since the early 1990's. As you can see by its design, it is from an original style where the left column is the navigation bar, instead of today's contemporary websites that have a drop-down Menu. From the onset, this site has been secure from viruses and malware and still is.
You may have noticed Google is now placing a padlock icon to the left of website addresses, which can be misleading if you do not know what it means. If the padlock has a red slash across it, this means that the website is not secure for credit card processing. A red slash does not mean the website is not secure from viruses and malware. To be secure for card processing, the website requires an SSL (Secure Socket Layer) Certificate and special coding for this purpose. However, “Information only” websites, like this one, do not require an SSL because no currency is being processed through the website. Still, Google is placing the padlocks on all websites, and this is very misleading to those who do not understand their meaning.
Before the SSL Certificate and Coding, “https:/” represented websites that were SSL secure for card processing and “http:/” websites were not. However, though an http:/ website is not secure for card processing that does not mean that it is not secure against viruses and malware.
Please be assured that websites with http:/, padlocks with red slashes, and pop-up warning signs are now an "automatic" response from Google crawlers when they come across a website that does not have an SSL (i.e., does not a padlock without red slash), even if the website does not require one (like information only websites) OR the website cannot be coded for an SSL Certificate because it is an original website design from the 1990's or earlier. This website is both…it does not require an SSL because it is an information only website and it cannot be coded for SSL because of its original design; hence it will always have the red slash over the padlock. .
This website contains over 1000 educational webpages, which our contemporary websites are not designed to accommodate any more. This is why I plan to maintain this original design website from Network Solutions, who guarantees all of its websites are all virus and malware free, whether of original or contemporary design, and currently I do not provide a website that processes card payments.
