Elementor #31111 - Integrated Health Solutions

Health and Wellbeing Assessment

Please answer the questions to the best of your ability. This assessment will give us a general overview of your health currently with a large influence on gut health. It is a useful tool in helping to work on the areas that you feel need support to improve your overall health and well being.

Note: All fields marked with a red asterisk * are required fields.

Name Age Email Phone (if wanting to be contacted by the Clinic) Diagnosed Medical Conditions (if applicable) Do you currently take medication for any diagnosed medical conditions? What is your first concern when it comes to your health?

Microbiome

Have you had antibiotics in the last 5 years?

Do you eat less than 3 cups of vegetables per day?

Do you experience high stress?

Have you tested positive to any other parasites or bacteria?

Do you eat processed foods?

Do you have less than one bowel motion daily?

Have you had an infection or illness where you've never felt quite right again?

Liver

Are you sensitive to chemicals, paints, or petrol fumes?

Do you wake between 2am and 4am and find it difficult to get back to sleep?

Do you experience headaches at the end of the day?

Do you feel nauseous?

Do you drink alcohol regularly?

Do you have a history of gallstones or liver disease?

Hormones

Do you experience mood swings?

Do you experience PMS or breast tenderness before menstruation?

Do you experience hot flushes or night sweats?

Do you experience irregular periods?

Do you experience low libido?

Do you have a history of hormonal imbalances (e.g., PCOS, endometriosis)?

Energy & Mental Health

Do you experience low energy during the day?

Do you feel anxious or easily overwhelmed?

Do you have difficulty concentrating or remembering things?

Do you feel low or depressed?

Do you experience insomnia or difficulty falling asleep?

By submitting your information, you consent to the way your information is used, as set out here, and in the Terms and Conditions & Privacy Policy on the clinic’s website.
Your Health Report is for educational purposes only.

Health and Wellbeing Assessment

Gut

Microbiome

Liver

Hormones

Energy & Mental Health

Call us

Opening hours

Consultation hours

Quick Links

Social Media