MELANIE TURNER NATUROPATH
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Health Questionnaire 

    Health Appraisal Form

    Please fill out this form as best you can.  When you are done, please click the submit button.
    Please tell me about the main reasons you would like to see a Naturopath.
    When were you diagnosed? What have you tried? Anything that makes it better/worse? What are the main symptoms? Was there any illness or stressful event that brought it on?
    Please write down any medications that you get from your doctor and any that you buy over the counter at the pharmacy. if none, please write "none".
    Have you ever been diagnosed with any of the following?
    Please include how you rate the pain on a scale of 1-10 and how often it occurs. Please detail what the pain feels like for you.
    Including any vitamins, minerals or herbs that you are taking, including homeopathics, or superfood powders. If none, please write "none".
    Length of cycle, heavy/light? If you aren't menstruating please explain why and detail how long it has been since your last bleed.
    Reasons why you don't sleep well, or any other comment you'd like to make
    with 1 being very low energy and 10 being the best you've ever felt.
Submit
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  • Home
  • Work With Me
    • Naturopathy
    • Naturopathic Testing
    • Naturopathic programs
    • Public Speaking and Workshops
  • Blog
  • About Me
    • Meet Melanie
    • Contact
    • Positive Feedback