On this page you will find links to 5 different forms, please download, print and fill each one out and bring them with you to your first appointment.


1. New Client Intake Form


This form asks for basic personal information, your major health concerns, past medical history, family history, past and present pharmaceutical and complementary medicine use and general lifestyle habits.


Download New Client Intake Form (PDF)


2. Multi Symptom Questionnaire


This questionnaire covers major symptoms and conditions you may be experiencing now or have in the past. Please number (or tick when specified) each box and include any additional information in the spaces provided.


Download Multi System Questionnaire (PDF)


3. Day Diet Diary


The purpose of the diet diary is for you to provide an unbiased record of your normal eating habits. Simply eat your typical diet for 7 days in succession and record it, along with accompanying details (as indicated on each page).


Download 7 Day Diary (PDF)


4. Food Frequency Questionnaire


This form asks for how much of a particular type of food you eat per day or week. Please indicate the quantity of the food and what type of food it is including brand names if applicable.


Download Food Frequency Questionnaire(PDF)


5. Privacy and Consent Form


Please ensure that you read and understand our privacy and confidentiality policy at Natural Health and Medicine.


Privacy & Consent Form (PDF)



Thank you for taking the time to complete these forms. We are aware that some are lengthy, however, to provide you with the highest standard of care, your co-operation is essential. Thank you once again and we look forward to meeting and working with you.


Note: All forms are in Adobe Acrobat PDF format, if you do not have Adobe's Free Reader installed on your system.


Download free copy of Acrobat Reader


Download Acrobat