Jillian Parkhurst
  • About Jillian

Jillian Parkhurst

  • About Jillian/
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Jillian Parkhurst

Medical Travel Plan Intake

Jillian Parkhurst

  • About Jillian/

1:1 Coaching: Medical Travel Prep Session
Please complete the form below so that I can learn a little bit about you, your challenges, and your goals prior to our first session together. Be sure to submit this form at least 24 hours prior to our call. Thank you!

 

Name *
This is not for diagnosis or treatment. This will act as a resource your upcoming appointment.
Ex. August 19th through August 24th. The 19th & 24th are travel days.
Be as specific as possible here with each item on your upcoming schedule. Practitioners: Include their line of work/area(s) of expertise. Is this your first appointment? Or are you an existing patient/client? Testing: What type of test(s) will you have? Ex. MRI, pulmonary function test, tilt table, etc. Any prep that you will need to do for testing to occur? Ex. no fatty foods for 48 hrs prior Procedure: What type of procedure is being performed? First time? How long does the procedure last? Any prep that will need to be done for the procedure? Ex. no food or water for 8 hours prior
If yes, who?
Be specific.
If yes, what are they? If not, are you seeking anything in particular?

Thank you for taking the time to reflect and share this information with me. I know that it can be emotionally and physically exhausting to do so.
I look forward to connecting with you soon. ~ Jillian

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