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Print and Complete

Once completed, please scan and email  these back to me, at least 2 FULL WORKING DAYS before your consultation.
* if you are coming for an  IN-PRACTICE / FACE-TO-FACE (F2F) consultation - BRING these WITH YOU! 

 

OR

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Complete on a PDF editor (OR some can be completed in EXCEL)

Once completed, please email these back to me, at least 2 FULL WORKING DAYS before your consultation.

Make sure the lighting and focus are GOOD please!

* if you are coming for an  IN-PRACTICE / FACE-TO-FACE (F2F) consultation - BRING these WITH YOU! 

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QUESTIONNAIRES 

  CONSULTATION  DOCUMENTS -    

  ADULTS 13+                              

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Medical & Health HISTORY 

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Medical SYMPTOMS Questionnaire (MSQ)

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STRESS Assessment

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DIARY-JOURNAL - Diet, Nutrition, Lifestyle (7-day)

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   +  STOOL Scale - Bristol Adult [REFERENCE]

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SLEEP Questionnaire

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ANXIETY Questionnaire (Hamilton Scale)

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Stress, Depression & Anxiety Questionnaire (IFM)

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MOOD-TYPE Questionniare

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BODY PAIN CHART

Please print and shade or mark the areas where your pain is most common - use the pain scale to "rate" your pain levels in each area.

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Female HORMONE Balance Questionnaire

 

OR

 

FEMALE - Full Intake Questionnaire (FM17)

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TINNITUS Questionnaire 

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DERMATOLOGY / Skin health issues CHART

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WOMAC Osteoarthritis Index

Pencil and notepad

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 SUPPLEMENT / MEDICATION SUMMARY

Please type up a list of all the medication & supplements you have / take -  using this document - save and email back to Dr Adele

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  CONSULTATION DOCUMENTS  -  

  6-12 years old 

History & Lifestyle Questionnaire

(Children 6-12 years old)

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7 day Diet & Nutrition Journal

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STOOL / POOP Scale - Bristol Children

Going for a Walk

  CONSULTATION DOCUMENTS  -   

  0-5 years old 

History, Diet & Lifestyle Questionnaire

(Babies & Children 0-5 years old)

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STOOL / POOP Scale - Bristol Children

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STOOL / POOP Description - Baby Nappy 

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