Susan Barendregt, MNT, BCHN

Susan Barendregt, MNT, BCHN

Please download and fill out each of the forms from either the Adult or Pediatric section below. By clicking on each link you will download that form to your computer. Once you have filled your forms out, scan and email them to, or fax to (608) 338-0429. Please make sure I receive your forms at least 2 days before your scheduled consultation so I will have time to review them before we meet.

Forms for Adult Clients

Forms for Pediatric Clients (13 or younger)

It is important that I receive your completed forms 2 days before the date of your scheduled appointment. Otherwise we will have to reschedule.