This is the questionnaire I ask all my clients to fill out before the first visit. As a naturopath I can only be as effective as the quality of the information I work with, so please, take your time and make your answers as complete as possible. The more detail you can give the more effective our first consult will be.
Current Health and Wellbeing What if any current health conditions or wellness issues are you aware of or concerned about?
Do you have a regular daily bowel movement?
Do you have any tendency towards loose bowels?
Do you have any tendency towards constipation?
Do you suffer from gas or bloating?
Do you get stomach pains?
Do you suffer from asthma or as a child?
Do you suffer breathing difficulties?
Do you suffer from blocked sinuses?
Have you suffered from ear infections?
Have you suffered from eye infections?
Do you get tonsillitis or sore throats?
Do you suffer from cold hands and feet?
Do you every suffer palpitations?
Skin Do you suffer from any skin conditions such as eczema, psoriasis, rashes, itching, spots or acnes? Please detail.
Do you get PMT signs – bloating, pain, mood changes?
Do you get headaches around your period?
Do you get vaginal thrush?
Do you get urinary tract infections?
Do you have trouble urinating sometimes?
Have you had any prostate issues?
Do you have trouble getting to sleep?
Have you ever suffered from depression?