ADVANCED CLINICAL NUTRITION - Dr. D. Smith (940) 761-4045 Welcome to our secure Client website! | Our Cell-Friendly Visitor website is: AdvancedClinicalNutrition.Com - Dr. Smith Has Over 90% National and International Client Health Success Record!

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2-FREE CONSULT REQUEST

3-CONTACT & COMPANY INFO

A-ABOUT DR. SMITH

B-COMPANY INFORMATION

C-SECURE CARD PROCESSING

D-INSURANCE CLAIMS

4-FAQ & LINKS

A-YES! WE CAN HELP YOU!!

C-AUDIO INTRODUCTION

5-WHAT OUR CLIENTS SAY

6-FREE SERVICES & MORE!

7-NEWSLETTER / SUBSCRIBE

A-ABOUT FREE EVALUATIONS

B-NEWSLETTERS 2014 to Now

C-NEWSLETTERS Prior 2013

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D-YOUTUBES-COMA, HAIR, WT

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F-THERAPEUTIC VITAMINS

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H-URINE - (BONE TESTING)

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J-BLOOD TEST THROUGH MD

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D-NOT TOO LATE TO HEAL!

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D-BLOOD TESTS FROM M.D.

25-REPORT OF FINDINGS

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1-DRUG FREE AMERICA

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19-MINERAL - IODINE

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28-SCARS,TATOOS,VAC SITES

29-ELECTROMAGNETIC (EMF)

30-CHILDREN HEALTH (YOUR)

31-REFLEX HEALING

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34-KEYS TO LONGEVITY

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B-PURIFIERS - AIR / WATER

C-CHI MACHINE-ALIGN SPINE

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31-PEP ADVANCED PROGRAMS

A-HEALTH CHEST EDUCATION

B1-DIETARY PLANS

B2-DIETARY PRINCIPLES

C-LIFESTYLE COACHING

D-MIND & BODY CONNECTION

E-ANATOMY DIAGRAMS

32-SPECIALIZED PROGRAMS

A-PERSONAL CARE PROGRAM

B-DENTAL HEALTH PROGRAM

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B-FOOD PRESERVATION BAGS

C-HOUSEHOLD PRODUCTS

D-LINENS-NATURAL FIBER

34-CLOSURE PROCEDURES

Want Results? Stop Taking The Wrong Vitamins! Best To Test Before You Buy!

 
 

INQUIRY CONSULTATION 

TO SCHEDULE YOUR FREE 
INQUIRY CONSULTATION WITH DR. SMITH

Please scroll down this webpage to complete 
our Inquiry Questionnaire form
    
and then to schedule your telephone 
appointment, please call 

(940) 761-4045

Office Hours:  10 a.m. to 5 p.m., 
Closed 12 to 1 p.m. for Lunch.

Please schedule this appointment when those who make the financial decisions for the family are present on the call, if not the same as the person in need of our Clinical Nutrition Services.

 
 
 

Document
Privacy Notice
 
 
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PURPOSE OF INQUIRY QUESTIONNAIRE
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Reviewing the Patient's Personal Information on the Inquiry Questionnaire, before the Inquiry Telephone Consultation with Dr. Smith, will allow her time to prepare an Initial Nutritional Assessment and Financial Plan so that she may recommend the specific services that best suits the patient's needs.  This also saves time at the Inquiry Telephone Consultation. 

If the Inquirer is not the Head of Household, please schedule the appointment at a time the parient, inquirer and Head of Household can be present, if not all the same. The Head of Household is the person who has the final word regarding financial decisions or who must be consulted so that a mutally-agreed financilal decision can be made at the time of the appointment.

Thank you!


 
  
INQUIRY QUESTIONNAIRE

Provide Patient Information, Unless Otherwise Requested.

DATE COMPLETED INQUIRY QUESTIONNAIRE:
PATIENT'S FIRST & LAST NAME:
NOT PATIENT? YOUR FIRST/LAST NAME & RELATIONSHIP?
AGE:
BIRTHDATE:
Email:
WHO OR WHAT REFERRED YOU? IF INTERNET, PLEASE LIST KEY WORDS.
YOUR TIME ZONE? (NOTE: APPTS ARE SET IN C.S.T.)
BEST DAYS & TIMES (C.S.T.) TO CALL YOU?
DAYTIME PHONE NUMBER:() -
EVENING PHONE NUMBER:() -
FAX NUMBER:() -
MAILING ADDRESS:
CITY, STATE, ZIPCODE:
COUNTRY:
#1 HEALTH CONCERN?
#2 HEALTH CONCERN?
#3 HEALTH CONCERN?
#4 HEALTH CONCERN?
#5 HEALTH CONCERN?
OCCUPATION:
EXPOSED TO CHEMICALS OR METALS AT WORK OR HOME? IF YES, LIST.
DID YOU READ ALL "WHY TEST?" WEBPAGES? YES OR NO.
DID YOU READ ALL "OUR SERVICES" WEBPAGES? YES OR NO.
DID YOU READ THE "ORDERING W.F. SUPPLEMENTS" WEBPAGE? YES OR NO.
IF YOU ANSWERED NO TO READING WEBPAGES, PLEASE PUT EITHER "I WILL OR WILL NOT READ BEFORE APPT."
DID YOU SUBSCRIBE TO DR. SMITH'S NEWSLETTER? YES OR NO.
IF YOU HAVE NOT SUBSCRIBED, DO YOU PLAN TO? YES OR NO.
INTERESTED IN IMPROVING CONCERNS, OVERALL HEALTH, OR BOTH?
DO YOU HAVE THE FINAL WORD REGARDING FINANCES? (YES OR NO) PLEASE ANSWER ACCURATELY. IF ANSWER IS NO, HEAD OF HOUSEHOLD MUST BE PRESENT AT INQUIRY CONSULTATION.
FIRST/LAST NAME OF HEAD OF HOUSEHOLD:
IF YOU WERE REFERRED BY A PERSON WHO IS NOT A CLIENT, PLEASE PROVIDE THEIR ADDRESS SO WE MAY SEND THEM A THANK YOU CARD.
IS THERE ANYTHING ELSE YOU WANT TO COMMUNICATE TO DR. SMITH?
 
 

Thank you for completing our Inquiry Questionnaire! 

We look forward to talking with you soon!

God Bless you and your family!


 
 
 

FOOTNOTE

Secure Website Info - Disclaimer - Copyright

Last Website Update: 02/06/2025 8 a.m. CST

Disclaimer:  Information provided in website for nutritional ducational 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   All Rights Reserved
  .NET 8/22/18

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Our website does not have a shopping cart because it is what is termed an "information only" website.  So our website has no need for a padlock.  Regardless of the reason, they are unable to add the padlock to our secure website because it is an older web design from the 1990's.  Therefore, no matter what warnings they may give you, rest assured that this website is secure.

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