Pre-Consultation Forms

Pre-consultation forms are designed to save you time in your initial consultation as well as allowing for a comprehensive review to be conducted prior to your first visit. 

Please complete all of the below forms including your Personal Profile, Online Health Appraisal Questionnaire and 3-Day Food Diary, 48 hours prior to your first consultation.

 

 

PATIENT PROFILE

Your personal profile is where your record the following details:

  • Personal details
  • Reason for visit
  • Body measurements
  • Medical Conditions, Medications and Supplements
  • Family History
  • Consent to T's & C's
 
 

Health Appraisal Questionnaire

  • This questionnaire is a valuable tool for your practitioner to gain information about your current symptoms and health concerns
  • All of your information provided remains confidential
  • Speak to your practitioner if you are unsure about any of the questions

 

 

3-DAY FOOD DIARY

The purpose of completing a food diary is to provide a snap shot of your typical food intake across the week. As our food intake can vary depending on our social activities I ask that you complete 3 entries for your food diary - two separate entries for 2 "week days (Monday to Friday)" and 1 entry for the "weekend" (Saturday OR Sunday).

After I receive your food diary, the data is entered into Food Zone and initial analysis is carried out. You will receive your dietary report post your initial consultation .

Please email your completed 3-Day Food Diary 48 hours prior to your initial consult.

 
 

 

Terms & conditions

Terms and Conditions are available for you to download.

Please return your signed copy via email together with your completed food diary.