Brigette's Natural Healthcare Academia Research Firm

Brenda Nelson-Porter, ND, DM

~If you are currently experiencing a medical emergency, call 911~

Initial Virtual Research

If resident wishes to continue to approach the underlying causes that stimulate his/her symptom(s) using natural health remedies, the facility representative (Licensed Medical Practitioner) must first obtain permission from the resident to complete this form the following form and then complete the form and submit $550.00 USD payment for services to via Paypal or Dwolla with the following message in bold:

I/We understand this natural healthcare service provider
(Brigette's Natural Health Academia Research Firm) is to provide this care facility representative, one (1) document to include research on natural approaches to the underlying cause(s) of the symptoms indicated in the form submission.
I/We understand this is a natural healthcare service and not a medical service that diagnoses diseases and/or provides prescription medications.


Facility Name:
Facility Representative Name Who is the Physician for the Named Below Resident:
Facility Representative Title:

Facility Contact Information:

To maintain confidentiality, the email above is where the suggestions for the residence will be emailed.

RESEARCH FOCUS: Here, specify the focus of the research requesting. If left blank, these factors may not be considered for the findings:

Condition/Illness (State Name):
[For residents with Cancer/Tumors, see the tab at the bottom of this webpage and disregard completing this form]

Age:     Gender:      Current Weight    Current Height:      Eye Color: 

Blood Pressure Today:    Recent Blood Work (Results):

Cholesterol Level Today:     Urine Description/Frequency:

Known Food Allergies:     Known Environmental Allergies:   

Known Topical/Skin Allergies:   Known Medication Allergies:

Current Medications Intake (Dose/Frequency):

Current Supplement Intake (Dose/Frequency):

Medical History: 

Diagnostic Test: Date of Last Test (State/Results):

Last Menstrual Cycle Start Date/Describe Flow (Females Only):

Personal Recreational Habits (Alcohol/Tobacco/Street Drugs/Frequency):

Food Consumption Preference: Vegetarian, Vegan, Semi-Vegetarian/Pescetarian, Omnivore (select one):  

Family Medical History:

Instructions: Type Your Explanations After Each Question. Do Not Remove the Text in the Textbox:






The Firm's Research Projects: The Firm Would Appreciate Your Participation. Thank You.


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Brigette's Technology Consulting and Research Firm 2014-2017
Brigette's Natural Health Advisory and Research Firm
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