Let’s learn about your current health.

Please take some time to fill in theĀ  Questionnaire below.

Name
Cancer, cardiovascular disease, mental health, Alzheimer's or dementia etc.

Do you follow a particular diet?
E.g. Vegan, Keto, Paleo
Breakfast, lunch, dinner and snacks.
How often do you eat takeaways or eat out?
Do you experience cravings for any particular food or drink?
E.g. Salt, sugar or alcohol
Do you have any food allergies or feel like you react to certain foods?
Do you eat when your not hungry?
E.g. Eat when you feel emotional or bored
How often do you eat "on-the-go" or in front of the TV, computer or on your phone?
Excluding caffeinated beverages
Do you drink coffee, caffeinated tea or energy drinks?
Do you drink alcohol?
Do you smoke cigarettes?
How often do you feel low in energy or fatigued?
How often do you experience a "3pm slump" or "crash in energy"?
How often do you exercise?
Please list
How often do you experience muscle soreness or aches in your body following exercise?
Do you often feel "wired" or experience increased energy in the evening?
How often do you wake up unrefreshed?
Do you experience high amounts of stress in your day to day life?
E.g. Work, financial, relationship
Do you prioritise time for yourself?
Do you consistently overcommit to things/people/activities in your life?
Do you have difficulty setting boundaries with others?
How often do you connect with family and friends?
How often do you spending time relaxing?
E.g. Meditation, deep breathing, music, journaling, spiritual or religious practices
Is your weight of concern to you?
Do you regularly experience constipation or diarrhoea?
Do you experience reflux, bloating or gas?
Do you suffer from headaches or migraines?
Do you suffer from recurring infections or frequent illness?
Do you have any skin concerns?
E.g. Acne, eczema, psoriasis
Do you use organic, non-toxic skin care and make-up?
Do you use eco-friendly, low-toxin home cleaning products?

For Women

Have you ever been on the oral contraceptive pill or other hormonal contraception?
Are you currently pregnant or breastfeeding?
Do you track your menstrual cycle?
i.e. 28-35 days
Do you experience PMS in the lead up to your period?
E.g. Bloating, cravings, irritability, breast tenderness
E.g. Pads, tampons, moon cup, period underwear

And finally..

Your number one goal.
Is there anything that typically holds you back from meeting your goals?