Health & Nutritional ADULT Assessment Questionnaire

If you’ve booked a Child’s appointment, please contact me and I will send you an alternative questionnaire.


This questionnaire will help me to know more about you in order to assess how best to improve your health.

Thanks for taking time to fill this in. I look forward to receiving your information and meeting you.

  1. Filling this form in on computer might be easier than on a mobile.
  2. This form can take a varied amount of time to fill in, depending on your health situation. On average it will take 45 minutes.
  3. You can SAVE DRAFT (button on bottom of every page) and come back to the form as many times as you wish. You will enter your email address and a link will be sent to you with instructions on how to return to the form. When you click that link, you can resume filling in the form.
  4. These changes will auto save every time you click the ‘next’ button. However, it’s recommended that you click the SAVE DRAFT every other page and as mentioned, especially when you want to save and return to it another time.
  5. The form is split into pages/session and you can jump between sections by clicking the page numbers or previous & next buttons. DON’T CLICK BACK in your browser else you might loose the info you’ve typed.
  6. Please ignore any numbers you will see ahead of information, e.g. 307 Pain in mid-back region
  7. Anything that does not apply: leave blank
  8. On completion, please double check each page in case you have missed anything or would like to change/add info.

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