New Patient Form

COMPREHENSIVE INITIAL HEALTH QUESTIONNAIRE

I’m looking forward to meeting you for your initial naturopathy appointment!

Please complete the following questionnaire, and remember to bring along to your appointment any test results (within 18 months) that are relevant to your health.

NEW PATIENT QUESTIONNAIRE (ADULT) – NATUROPATHY

Thank you for choosing our practice to assist you in reaching your health and wellness goals! To ensure you receive the highest level of care please complete the following questionnaire as best as you can. The information you provide is kept completely confidential.

APPOINTMENT DETAILS – A BRIEF OVERVIEW OF WHAT TO EXPECT

Step 1 is to complete this form and email back within 48 hours of your scheduled initial appointment. Please also include other relevant health test reports (e.g. pathology – from within 18 months).

Step 2 is your initial appointment, where we will discuss your main health concerns drawing on health history and signs and symptoms, as well as current dietary and lifestyle related influences. Some in-clinic physical testing will be performed and may include a VLA Bio-impedance test, blood pressure/ pulse check; analysis of eyes, nails, tongue and any other physical examination deemed necessary (e.g. thyroid palpation, auscultation). Your initial treatment plan is devised.

VLA BIO-ELECTRICAL IMPEDANCE ANALYSIS TESTING

If you’ve booked an appointment that includes Body Composition testing (VLA Bioimpedance) please follow these instructions in order to achieve an accurate baseline for the BCT.

  1. Void bladder immediately before the test
  2. Drink plenty of water on day of test
  3. Avoid strenuous activity at least 2 hours prior
  4. Do not eat within 2 hours of the test

Step 3 is your first follow-up (2nd appointment) where we will go through your ‘Report of Findings’. This appointment will occur within 2-3 weeks of your initial appointment. At this appointment we will review your VLA Bio-impedance testing results, and any further pathology/ other testing results. We will re-assess your health goals based on these results, and further expand and/ or ‘tweak’ your treatment plan.

Step 4 is where we will stay on top of your health, with further standard follow-up appointments that are typically of shorter duration. These appointments are for treatment plan progress reviews, mentoring and coaching, addressing new signs and symptoms and adjusting protocols if required.

At each appointment will include a treatment plan based on subjective and objective information attained about your health. Further testing such as Pathology or Stool analysis may be required and if so will be explained fully during the consultation.

COMPLETING THE QUESTIONNAIRE

Please answer each question in as much detail as possible including dates.