Services > Client Intake

To better serve our clients we ask that you complete some paperwork prior to your first appointment at InsideOut & Within. Please download the client intake form, fill it out and fax it to us at 281-561-8222, or email it to us at   jacksoninsideout@aol.com and we will process your Client Intake Form promptly. 

You will NOT be able to have a colonic without a prescription written from either your physician or my physician PRIOR to your colonic. 

The form is in Adobe Acrobat, if don't have the reader you can download it from the Adobe website.

The client intake packet includes:

• Client History
• Prescription Information
• Informed Consent

Thank you for your assisting us in making this process as easy as possible. We look forward to serving you.