We accept new patients both locally and long distance

One-on-one 24/7 individual care

MINERAl REBALANCING PROGRAM

On-going testing to track progress

Custom NUTRITION & SUPPLMENTATION

Personalized RECOMMENDATIONS

Detoxification protocols

Therapeutic services

cellular health improvement

Each patient will undergo serial hair tissue mineral analysis (HTMA), organic acids testing (OAT), and GI map testing in order to address mineral deficiencies, heavy metal toxicities, and other imbalances at the cellular level that correlate with chronic health problems. (Some patients require other types of testing based on specific conditions.)

Patients are required to follow Dr. Robert Selig’s plan 100%, so we provide 24/7 care by phone and email to address your concerns and answer your questions. Our methods are scientifically proven to help you heal faster, more efficiently, and with less pain. **It is very important to be under care of a practitioner when starting a proper detox program.

Typically care plans cost between $3.5-6k for full health management for 5 months which includes recommended specific tests, supplements, and therapies, however pricing is on an individual basis based on a patient’s condition. We do require payment to begin testing as our plans are unfortunately not covered under health insurance.

Please fill out this form TO SCHEDULE your free consultation with Dr. Robert Selig and get custom pricing. We respect your privacy and do not share your information.

Is this application for you or a family member? *
Have you had a hair tissue mineral analysis? *
Name of person requesting treatment *
Name of person requesting treatment
Gender *
Phone *
Phone
It is important to fully assess your background from birth.
Birthdate *
Birthdate
Address *
Address
Status *
Important for determining stress factors.
Live with *
Pets *
Furthest Education *
Please type NA if not available.
Please type NA if not available.
Work Status *
Have you served in the military? *
Alternative therapies
How would you rate your experience with alternative therapies? *
Hair Tissue Mineral Analysis, Detoxification, Nutritional Balancing and Supplementation, etc.
Have you ever been treated with homeopathic therpies? *
Have you ever been treated with chiropractic therapy? *
General Health Questions
Please list as many as you can in order of importance*
Please type NONE if you do not currently take any medications.
You took these medications for a long period of time but no longer do.
Personal Health Rating *
On a scale of 1-10, (1 = poor, 10= optimal) how would you rate your health?
How would you describe your personal health? *
How would you describe your vitality, stamina, and energy? *
Are you a warm or cold person? *
Do you prefer warm or cold drinks? *
What childhood illnesses have you had? *
Which tests have you undergone? *
Which immunizations have you received? *
Type of Illness/Operation | Date | Location
Please select all that apply to you current state of health: *
Venereal diseases (Gonorrhea, Syphilis, etc.)
Which of these do you consume or use? *
Type NONE if you are not allergic to any drugs.
Type NONE if you are not allergic to any foods or other substances.
Family Health History
Mother *
Father *
Siblings *
Grandfather (Mother's side) *
Grandmother (Mother's side) *
Grandfather (Father's side) *
Grandmother (Father's side) *
Has any blood relative had any of the following? *
General Pain Symptoms
It is very important that you answer ALL that apply to you.*
Neck Stiffness
Neck Pain and Swelling
Radiating Neck Pain
Whiplash
Neck Injuries
Middle back stiffness, dull pain
Herniated Disc(s)
Arthritis (Middle Back)
Middle Back Injuries
Radiating Pain (Middle Back)
Lower back stiffness, dull pain
Lower back radiating pain
Herniated discs (lower back)
Lower back arthritis
Lower back injuries
Limbs (joint pain, swelling, stiffness, tingling, numbness)
Limbs (muscle cramps)
Burning of soles of feet
Unusual redness of the palms or hands
Where? What kind?
Where?
Current health problems
Cardiovascular System
Endocrine System
Blood, Lymph, and Immune Systems
Respiratory System
Nervous System
Digestive System
Bowel movements *
Skin and Hair
Hair
Head
Eyes
Ears
Nose
Mouth
Throat
Mental and emotional
Urogenital system
Male problems
Female problems
Average flow
Trouble with lactation?
Do you have nipple discharge?
Sleep and Dreams
Sleep problems and irregular sleep patterns
Sleepy during the day
Do you usually dream?
Do you remember your dreams?
Insomnia
Do you wake up unrefreshed?
Do you feel sleep deprived?
Nightmares | Bad dreams
Too hot or cold during sleep
Nightsweats
Are you presently on any of these treatments? *
Weight, skin, hair, teeth, stomach, sleep, depression, etc.
These are health problems that you struggled with but no longer do.
Improvements or lack of improvement in treating your health problems, sleep, vitality, mental and emotional state, etc.
How did you hear about our services? *