Holistic Questionnaire

Complete the Iyasu Colonics holistic questionnaire prior to your visit so that we can be better prepared to serve your needs.





























    What do you eat for the following meals? (Please be specific)













    By returning my completed questionnaire, I agree to the following:

    24 Hour Cancellation Policy:*

    I also agree if I fail to show up for my appointment with no communication with Stephanie, Iyasu will not retain me as their client.

    Iyasu Disclaimers:*




    “If you’re looking to go deep on many levels, this colonic spot incorporates energy work, essential oils, crystals and aromatherapy.”

    Goop’s Beauty & Wellness Detox Guide