This questionnaire is designed to gather all the informatin necessary to support your first consultation and build your individual nutritional programme. It covers each organ system and symptoms related to these systems. Many systems overlap and in some situations similar questions may be repeated to present an accurate assessment. Please allow up to an hour to complete this questionnaire. Time taken at this stage will enble more time to be focused, during your consultation, on your condition.

We look forward to discussing these results in more detail at your first consultation.

It is important to assess the average level of nutrients consumed over a typical period. For this reason can you indicate the food and liquid taken each day over a 3 day period for : breakfast, lunch and dinner, including snacks and drinks.

The next sections ask you to click the button that best represents your answer to each question.

You can use your tab buttom to move from question to question and there is a submit button at the end of the final section.

Please indicate any medications you're taking or have taken in the last month