FLT Script Pad Name* Date* MM slash DD slash YYYY I am recommending the FirstLine Therapy Therapeutic Lifestyle Program for you because it is effective in managing some of the health conditions you have which are checked in the list below. The FirstLine Therapy Program is available at this office. Please contact 21st Century Total Wellness at 219.613.1161 if you have any questions.Conditions for which the FirstLine Therapy Therapeutic Lifestyle Program is recommended: Arthritis Alzheimer's Disease Cardiovascular Disease (CVD) Diabetes Type II Fatigue High Stress Lifestyle Hormone Imbalance Insulin Resistance -- Pre-Diabetic Interest in Healthy Aging Metabolic Syndrome Osteoporosis/Osteopenia Overweight Pain Physical Inactivity Sarcopenia/Sarcopenic Obesity Additional conditions: Hyperlipidemia Please select the one which applies to your Hyperlipidemia: Elevated LDL Elevated Total Cholesterol Elevated Triglycerides Low HDL Other Coronary Heart Disease (CHD) Risk Factors Please select the one which applies to your CHD: Abdominal Obesity Atherogenic Diet Cigarette Smoking Elevated C-Reactive Protein (CRP) Elevated Homocysteine Family History of CHD High Blood Pressure Physical Inactivity Waist-to-Hip Ratio > 1 Other:
