New Patient Paperwork

The documents below can be printed and filled out before you come into the clinic.

Consultation Information Sheet

Personal Information

Last Name		First Name			Middle Initial
Date of Birth	Sex	Weight /Height	Age
Address
City		State		Zip Code
Home Phone		Cell Phone
Occupation		Email Address

Allergies O None O Unknown Medical Allergies: ________________________________________________________________________________________________________________________________________________________________________________________________________	Cardiac O None O Unknown O Angina O Arrhythmia O Cardiomyopathy O CHF O Congenital O Implanted Defib O MI Other______________________________________	Surgery O None O Unknown O Abdominal O Heart O Lung O Neurological Other__________________________________________________________________________________________________________________________________________________
Chronic Illnesses
O None O Asthma O Bleeding Disorder O Cancer-Any O Cyst-Any O CVA / TIA O Diabetic      O Type 1      O Type 2	O Dialysis/Renal O Gall Bladder O Gastrointestinal O Gout O Headaches O Hepatitis O HIV + O Hypertension O Paralysis	O Psychological O Seizures O Substance Abuse O TB O Unknown Other________________________________________________________ ____________________________________________________________
Current Medications AND Medical Conditions in the Past Year O None O Unknown _________________________________________________________ ______________________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

Past Medical History

Emergency Contact Information

Primary Physician	Physician Phone Number
Primary Contact Name & Relationship	Primary Contact Phone Numbers
Previous Methods of Weight Loss ___________________________________________ How did you hear about us? _________________________________________	Results

Please Select Program Options of Interest O HCG Injections                                                    OHCG Nasal Spray O Hypnosis                                                             O HCG Cream O HCG Oral Drops                                                  O Prescription Weight Loss Aids O Non-HCG Weight Loss                                        O Body Sculpting O Exercise                                                               O Other __________________________________ O One on One Weight Loss Counseling                               __________________________________ O Group Weight Loss Counseling

______________________________________           _____________________________

Patient Signature                                                            Staff Representative Signature

__________________________________                   _____________________________

Date                                                                                Date

hCG and Coconut Oil

hCG and Coconut Oil

The Weight Loss Cure introduced the benefits of Coconut oil on the hCG diet. Although Organic Coconut Oil is a saturated fat, it is one of the few truly good saturated fats with some unique benefits to your health. It is the only fat approved on the hCG diet and is used for cooking and can be used your skin. 

Benefits of Coconut Oil 

• Stimulates the thyroid 

• Increases metabolism 

• Lowers cholesterol 

• Lowers blood pressure 

• Better protection against chemicals that cause cancer in the breast and colon 

• Contains linoleic an Omega 6 polyunsaturated fatty acid 

• Contains 40% Lauric Acid (found in breast milk) which boost your immune system and protects against viral, bacterial and protozoan infections 

• Heals your skin similar to the way Aloe Vera heals 

• Alleviates dry skin issues such as psoriasis and eczema 

• Stops wrinkles, prevents and fads dark spots and stops loose skin 

• Prevents Dandruff, lice and lice eggs 

• Helps in hair re-growth 

You can use Coconut Oil for cooking on the hCG protocol because unlike other fats Coconut Oil is used by your body like a carbohydrate. Your body breaks the coconut oil fat down much quicker within the liver and does not store it like other fats. 

With the addition of Coconut Oil to the hCG diet, it is still best to limit the amount you use. Using a 1/4 to 1/2 teaspoon in stir frying foods or oiling your grill for cooking is enough. Using a little on skin in lieu of mineral oil is okay as well. 

Fat Forecast: 42% of Americans Obese by 2030

About 32 million more Americans will become obese by 2030, upping obesity rates to 42 percent of the U.S. population, according to a new report from the U.S. Centers for Disease Control and Prevention.

The report also predicts that the proportion of Americans who are severely obese, meaning more than 100 pounds overweight, will reach 11 percent, about double the current rate.

The report's authors give a sobering price tag for these predictions: such an increase would create $550 billion of obesity-related health care costs.

Eric Finkelstein, one of the authors of the report, said the prospect of such increasing rates, particularly those of severely obese Americans, is alarming since efforts aimed at helping people lose weight have so far proven relatively ineffective.

"Their weight continues to increase. Over the last 10 years, it has gone up tremendously," he said in a press conference. "This is a group at great risk of health complications, and yet they are increasing at an even greater rate than the rate of obesity."

The report was published in the American Journal of Preventive Medicine and was released at the CDC's Weight of the Nation conference today, a gathering focused on the impact of the obesity epidemic. The authors analyzed data collected from each state and made projections based on a number of factors influencing obesity rates, including the cost of healthy and unhealthy foods, gas prices and Internet access.

"Predicting obesity is tricky and no one variable showed up as causing obesity," Finkelstein said.

Although recent data suggest that rates of obesity have reached a plateau, current rates of obesity are still alarmingly high. About 34 percent of adults are currently obese, creating a whole host of expensive, chronic health problems, such as cardiovascular disease and diabetes.

The report's authors said a number of factors could lead to the predicted rise in obesity. About two-thirds of Americans are currently overweight and could continue to gain weight and move into the obese category.

Dr. William Dietz, one of the study's authors and director of the CDC's division of Nutrition, Physical Activity and Obesity, also noted that children who are currently overweight or obese will likely be a major source of the increasing rates.

"We know that about 50 percent of severe obesity in adults is consequence of obesity in childhood," he said.

Currently about 17 percent of children and adolescents are obese.

Anti-obesity measures such as better urban design, access to recreational facilities, workplace health promotion and new drugs could help reign in the problem, the authors noted.

Posted by ABC News.

A few of the many benefits of hCG

The Many Benefits Of 
hCG for Weight Loss

It was discovered that along with substantial weight loss and the ability to keep it off after the program was complete, there were many more benefits experienced from being on this program.

Here are a Few:

a) No loss of muscle mass

b) Normalized the thyroid gland

c) rebuilds the adrenaline glands

d) balances the hormones out put

e) replaces the good cushioning "fat pad" throughout the body

f) normalizes cholesterol levels

g) normalizes appetite demands

h) improves ones "singing voice"

i) gets rid of large pot belly on both male and female

j) reduces fat deposits on double chins


k) lose between .08-2 pounds per day

l) resets hypothalamus and metabolism to make weight maintaining long term

m) targets problem areas

n) increases skin elasticity

o) skin tightens and refirms in areas that would normally result in sagging skin

hCG Strawberry Vinaigrette

Strawberry vinaigrette 

Ingredients
1 serving (1 fruit)

• Strawberries
• 1 tablespoon apple cider vinegar
• 1 tablespoon lemon juice
• Stevia to taste
• Dash of salt
• Dash of cayenne (optional)
• Fresh ground black pepper to taste

Directions: Combine all ingredients in food processor. Puree until smooth. Pour over
fresh green salad. Garnish with sliced strawberries and freshly
ground black pepper. Variations: use as a marinade or sauce for chicken.

hCG Ketchup Recipe

Sugar-Free Ketchup

Here's what you'll need...

•   2-3 ounces – pureed tomatoes

•   3 Tablespoons - Apple Cider Vinegar

•   1 Tablespoon - Lemon Juice

•   1/4 teaspoon - Celery Salt

•   1/2 teaspoon - Paprika

•   1/4 teaspoon - Mustard Powder

•   1/4 teaspoon - Onion Powder 

•   1/4 teaspoon - Garlic Powder 

•   Tiny Pinch - Nutmeg

•   Tiny Pinch - Clove 

•   Stevia to taste

Directions: Dissolve spices in the vinegar and lemon juice. Then add the pureed tomatoes and mix thoroughly.

If needed: Add additional lemon juice, vinegar, or a little bit of water until it reaches your desired thickness.