Private Health Consultation

Consultation Process

What's involved in a natural health consultation?

Click through the 6 steps below to see a summary of the full health consultation process

Holistic Health Consultation

First name

Last name

Date of Birth

Day

Month

Year

Town/Region of birth

Time of birth (if known)

Email Address

Phone

Occupation / Job

Your Height (cm)

Your Weight (kg)

Are you...

Pregnant

Soon to become pregnant

Breastfeeding

None

Diet & Nutrition

General

Have you ever been diagnosed with any food-related conditions?

On average, how many meals do you eat each day?

2-3

Do you typically snack between meals, if so what do you eat?

How many portions of fruit do you eat per week (average)

0-2

3-5

How many portions of vegetables do you eat per week (average)

0-2

3-5

How many times do you eat processed foods (including pre-packaged food) per week (average)

0-2

3-5

How many times do you cook with wholefoods per week (average)

0-2

2-5

How many sugary foods do you consume per day on average (do not include fruit)

1-2

How many litres of water do you drink per day (average)

0-1

1-2

Other

How many alcoholic drinks do you consume per day (average)

1-2

If you know, how many units per day

How many caffeinated drinks do you have per day (coffee, black/matcha tea, red bull etc)

1-2

3-5

I live on coffee

Do you often drink caffeinated drinks after 4pm?

Do you consume sugar substitutes or sugar-free drinks? Briefly describe them and how regularly you drink them

How many cigarettes do you smoke per day (average)

I've never smoked

1-5

5-10

10+

I've quit smoking

I use a vape pen

When you were a child, what body type/shape were you?

I was small or thin, with small bones

I was average for my age, neither large nor small

I was a larger child with big bones

Has your body type/shape changed since then? If so, how?

Movement

Is there anything preventing you from exercising?

How many times per week do you engage in physical activities (average)

Rarely

Once or twice

Daily

What type of activity is most common

For how long each day? (average)

0-30 minutes

30-60 minutes

Over 1 hour

What time of day? (average)

Early (4-12)

Afternoon (12-5)

Evening (5-8)

Late (8-12)

How many hours per day do you spend sitting (average)

0-3

4-6

7-10

11+

Sleep, Stress & Social

How many hours of sleep do you have per night (average)

0-4

4-6

7-8

When do you usually go to sleep?

7-9pm

9-10

10-11

11+

Would you describe your sleep as...

Deep and undisturbed

Light and easily disturbed

It varies

Do you usually wake up feeling...

Well-rested

Tired

It varies

How do you typically handle stress?

By exercising

By eating

Through alcohol / drugs

Seeing friends

Other

How effective is your stress management?

How often do you socialise with people per week (other than family)

Never

Once or twice

Regularly

Daily

Medical History

Have you been diagnosed with an ongoing condition?

Have you ever been diagnosed with a condition you no longer have?

Do you have any long-term recurring symptoms?

Do you have a family history of specific illness? (back to grandparents on both sides)

Physical Assessment

If we're unable to see each other in person, a few photos will provide a great deal of information I can use in your assessment. Please photograph and send me photos of the following (the higher quality the better)

Your hands, focusing on your nails

I will

How?

Prefer not to

Your eyes, either together or each separately

I will

How?

Prefer not to

Your tongue, as much as you can

I will

How?

Prefer not to