Simply Wurth It

Medical Weight Loss · Hormone Optimization · Labs

SW

Current Weight

Goal Weight

Pre-Pregnancy Weight

GLP-1 Candidate?

Yes No Not yet — BF Discuss at follow-up

BHRT Candidate?

Yes No Not yet — BF Labs needed first

Recommended Services

New Mom Intake Consult Metabolic Reset Program Hormone Optimization GLP-1 Program BHRT Initiation Maintenance Membership

Provider Notes

Zephyr Sport & Spine

Chiropractic · Pelvic Floor · Diastasis Recti · StarFormer

ZS

Diastasis Recti — Finger-Width Gap

Location of Separation

Above At Below All 3

Depth / Tension

Mild Moderate Severe

StarFormer / RF Candidate?

Yes — now Yes — Phase 3 Not indicated

Chiro Adjustment Indicated?

Yes No After healing

Recommended Services

Posture & Diastasis Consult Pelvic Floor Rehabilitation Core Reconnection Program StarFormer HITS Series Dry Needling Wellness Chiropractic

Provider Notes

TRU Med Spa

Botox · Fillers · Chemical Peels · RF Microneedling · PRP

TRU

Neurotoxin (Botox/Dysport) Interest

Yes — now Yes — post-BF No

Confirm BF status before scheduling

Filler Interest

Yes — now Yes — post-BF No

Chemical Peel Candidate?

Yes — superficial Yes — medium Post-BF only Not indicated

RF Microneedling Candidate?

Yes — now Yes — Phase 3 Not indicated

Recommended Services

Melasma & Pigment Peel Protocol Advanced Chemical Peel Series Neuromodulator Treatment Dermal Filler RF Microneedling Series PRP Hair Restoration Stretch Mark Treatment

Provider Notes

AN Aesthetics

HydraFacial · Custom Facials · Skin Health · Tanning

AN

Skin Type

Fitzpatrick Skin Type

Current Skincare Routine?

None Basic Established

Skin Concerns (check all that apply)

Dehydration / dullness Postpartum acne Sensitivity / redness Hyperpigmentation Clogged pores / congestion Collagen loss / elasticity Back acne (hormonal) Uneven texture

Recommended Services

Skin Condition Consult (complimentary) HydraFacial Series Custom Medical-Grade Facial Hydration & Brightening Protocol Back Facial (hormonal acne) Spray Tan

Provider Notes

Luxe Living with Laurie

Massage · Lash & Brow · Head Spa · Body Wraps · Waxing

LL

Recommended Services

Postpartum Recovery Massage Lymphatic Drainage Massage Lash Set / Extensions Brow Service Head Spa Treatment Body Wrap Waxing Back Facial

Provider Notes

Michelle Inouye Counseling

Postpartum Therapy · Art Therapy · Couples · Identity & Body Image

MI

Edinburgh PND Score (if screened)

Score ≥10 = refer promptly

Referral Urgency

Routine Soon (1–2 wks) Urgent

Insurance Verified?

Yes No Self-pay

Recommended Services

Postpartum Emotional Wellness Intake Individual Therapy (PPD/PPA) Identity & Body Image Therapy Art Therapy Couples Therapy Birth Trauma Processing

Provider Notes