Naturopathic Medicine Client Screening

Please review and complete the client screening form to request an appointment.

Thank you for your interest in Intuition Wellness Center. Here is some information that may be helpful:

  • Intuition Wellness Center medical services serves children ages birth and up and their caregivers.
  • Self pay fees for services are available to view on our Fee Schedule.
  • Naturopathic medical services are not billed directly to insurance. You may request a superbill.
  • If you are seeking information on our Wellness Programs, you are not required to complete the following questionnaire.
  • The questionnaire below is required in order to determine Intuition Wellness Center’s ability to meet your needs. To request services, please call 520-333-3320 or complete the following prospective client questionnaire:









    Self (adult)ChildFamily





    MaleFemaleOther










    Health ProfsSana NetworkInternet (eg., Google)PCPOther ProfessionalOther



    Get EstablishedWell Baby/ChildSports PhysicalSick-AcuteOther





    YesNoNA, prospective client is an adult



    YesNoNA, prospective client is an adult



    Please supply supporting court documents at intake or scan and email them to contact@intuitionwellness.com prior to your intake appointment.



    MedicalBehavioral HealthOtherNone


    If you have previous behavioral health or medical treatment history, please bring a copy of records (e.g., treatment summary, treatment plan, testing reports, etc) at the initial intake appointment. You can also email PDF documents to contact@intuitionwellness.com.


    Thank you for taking the time to complete the questionnaire. Please click “Request an Appointment” to submit to the Intuition Wellness Center team for review and processing.


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