Pre-consultation

Health questionnaire

Please complete this secure form at least 48 hours before your first consultation. It helps me prepare thoughtfully for our time together.

Your appointment may be postponed if this questionnaire is not received at least 48 hours before your scheduled session.

Full nameEmail addressProgramme bookedFirst consultation date (if known)

Health summary — symptoms, concerns, and relevant historyCurrent medications and supplements (if any)What you hope to achieve from our work together

Your responses are handled in line with our Privacy Policy.