Intake Form

These questions help me gain an initial insight into your health and medical history prior to our meeting.  A more in-depth case history will be taken during the initial consultation.

Name *
Name
For example: Diabetes, IBS, cancer, high blood pressure, thyroid disorder.
For example: Diabetes, IBS, cancer, high blood pressure, thyroid disorder.
For example: Omnivore, vegetarian, vegan.
I accept the terms and conditions *
o You are responsible for contacting your GP or specialist about any health concerns you may have. o Please advise your GP of the naturopathic nutrition protocol you will be following. Please also advise any other complementary medicine practitioners you are consulting. o It is important that you tell your practitioner about any medical diagnosis you have received any prescription medication, herbal medicine or food supplements or over the counter medication you are taking as it may affect the naturopathic nutritional programme. o If you are unclear about any part of your plan then you should contact your practitioner immediately for clarification. o Your naturopathic nutritional programme and supplement plan will have a time frame and you should not continue with recommendations outside of this unless agreed by your naturopathic nutritional practitioner. This is to avoid any adverse reactions. o Please report any concerns about your programme to your naturopathic nutritional practitioner for discussion at your next consultation.