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Please complete this questionnaire as fully as you can and
return it to me together with your food diary in advance
of our scheduled meeting. in advance of our scheduled
answer but please do what you can to give us a starting
point to work from.

Client Information

Thanks for registering to our event. See you there!

Are you currently seeing a specialist or GP?
Do you have any significant health issues?
Have you ever had any surgery/operations?
Have you been diagnosed by a medical practitioner for the area you are seeking help with through healthy eating?
Are you taking any medications? Including vitamin supplements

Further details:

Health Area for Focus

What is the most important area of concern that you wish to address? i.e. weight loss, better immunity, etc.

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Why do you want to address this health area?

On a scale of 1-10, how much importance do you attach to addressing this area of concern (1
being the lowest and 10 the highest level of importance.)

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