1hls quesLlonnalre ls deslgned Lo provlde your nuLrlLlonlsL wlLh all Lhe lnformaLlon necessary Lo bulld you an lndlvldual program speclflcally Lallored Lo your needs. lease provlde deLalls as fully and accuraLely as posslble. lf aL any Llme you need more space please conLlnue on a separaLe sheeL. LkSCNAL DL1AILS 1lLle______ llrsL name____________________ LasL name________________ MarlLal SLaLus ____________ Address __________________________________________________________________________________ ______________ osL Code _____________ L-mall _______________________________________________ 1el. number (moblle)__________________________ 1el. number (work)_____________________________ uaLe of 8lrLh ____________ Age __________ CccupaLlon _________________________________________ nLAL1n kCIILL WhaL ls your maln reason for seeklng nuLrlLlonal advlce? __________________________________________ WhaL ouLcome are you hoplng Lo achleve? ______________________________________________________ lease llsL your healLh concerns you would llke Lo focus on, ln order of lmporLance? ConLlnue on a separaLe sheeL lf you need more space.
PealLh roblem (e.g. arLhrlLls) ManagemenL so far (e.g. C, operaLlon, exerclse, paraceLamol eLc.) under whaL clrcumsLances does Lhe healLh problem lmprove/ worsen? CnseL (daLe) uuraLlon 1.
2.
3.
4.
3.
Pave you had any recenL healLh LesLs? lease speclfy or aLLach, lf approprlaLe _________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Pave you had any oLher ma[or surgery, blopsles, dlagnosed medlcal condlLlons, slgnlflcanL perlods of lll healLh or do you suffer from any chronlc or nlggllng healLh problems? (please glve deLalls e.g. hlgh blood pressure, frequenL colds, recurrenL urlnary lnfecLlons eLc.) _________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ uo you suspecL your sympLoms relaLe Lo a parLlcular evenL or Llme ln your llfe?_________________________
MLDICA1ICN & kLMLDILS lease llsL anyLhlng you Lake regularly lncludlng C prescrlbed medlcaLlon, self-prescrlbed medlcaLlon (e.g. palnklllers) nuLrlLlonal supplemenLs, herbal or homeopaLhlc remedles. ConLlnue on a separaLe sheeL lf necessary.
8emedy
uose CondlLlon belng LreaLed lrequency & uuraLlon
AnLlbloLlc hlsLory: please sLaLe when and why you lasL Look anLlbloLlcs plus any prevlous Llmes you can remember:
CUk VI1AL S1A1IS1ICS
_____ WhaL ls your normal blood pressure? _____ your resLlng pulse raLe per mlnuLe? (!"# %&"#'( )* %+,,+-. ("/-0 1*'23*( 2-( 42'5 /&*- !"# ,26* !"#1 7#'%*8 9"#-, ,&* -#5)*1 ": )*2,% +- ;< %*4"-(%). ________ your currenL welghL? (wlLhouL cloLhes) ________ your helghL? (wlLhouL shoes) ________ your walsL clrcumference? (lf known) ________ your hlp clrcumference? (lf known) ________ your blood Lype? (lf known) ________ ls your welghL sLable, lncreaslng or decreaslng? ______ uld you have Lhe normal lmmunlsaLlons as a chlld? CUk IAMIL nIS1Ck
uo you have a famlly hlsLory of dlsease or allergles? (e.g. hearL dlsease, dlabeLes, asLhma, eLc.) SLaLe dlsease, age aL onseL & gender.
CUk DAIL LIIL _____ uo you have any chlldren? lf so, how many? __ _____ uo you en[oy your dally llfe? _____ Pow many people depend on your supporL? _____ uo you feel supporLed by people around you? _____ Are you recenLly separaLed/dlvorced/a new parenL? _____ Are you recenLly bereaved? _____ Pave you moved house or changed [obs recenLly? _____ uo you work long or lrregular hours? _____ ls your workload blgger Lhan you can manage? _____ Are you under slgnlflcanL sLress ln any oLher way? _____uo you feel gullLy when you are relaxlng? _____ uo you have a perslsLenL drlve for achlevemenL _____ Are you especlally compeLlLlve? _____ uo you ofLen do 2 or 3 Lasks slmulLaneously? _____ uo you Lake regular exerclse? _____ ls your [ob acLlve? _____ uo you have any acLlve hobbles? _____ uo you have dlfflculLy geLLlng Lo sleep? _____ uo you experlence unlnLerrupLed sleep? WhaL do you do for relaxaLlon? ________________- ________________________________________ 8CD SCAN lease unuL8LlnL or PlCPLlCP1 any condlLlons LhaL you regularly experlence na|r olly, dry, poor condlLlon, brlLLle, Lhlnnlng, premaLurely grey, dandruff, lncreased faclal halr, lncreased body halr, decreased body halr Mouth sore Longue, LooLh decay, mouLh ulcers, bad breaLh, sore LhroaLs, poor sense of LasLe, excess sallva, dry mouLh, dlfflculL swallowlng, hoarse volce, glnglvlLls, bleedlng gums, cold sores, chronlc coughlng, frequenL need Lo clear LhroaL, swollen or dlscolored Longue/gums/llps, canker sores Lyes burnlng, grlLLy, proLrudlng, prone Lo lnfecLlon, sLlcky, waLery, lLchy, palnful, poor nlghL vlslon, dry, caLaracLs, senslLlve Lo llghL, bags or dark clrcle, swollen eyellds, blurred vlslon, double vlslon, falllng eyeslghL, yellowlsh Nose sLuffy, congesLed, runny, frequenL nose bleeds, prone Lo snorlng, slnuslLls, hay fever, posL-nasal drlp, rhlnlLls, sneezlng, poor sense of smell Musc|es Lender, sore, cramps, spasms, LwlLches, loss of Lone, wasLlng, weak, sLlff, frozen, 'resLless legs', numbness Sk|n dry, rough, flaky, scaly, puffy, pale, brown paLches, change ln moles or leslons, premaLurely llned, congesLed, olly, clammy, yellow, flushlng/hoL flushes, halr loss, acne, plmples, rosacea, eczema, dermaLlLls, psorlasls, rashes, bolls, hlves, lLchlng, sLreLch marks, cellullLe, easy brulslng, Lhread velns, varlcose velns, rlngworm, allerglc reacLlons, excesslve sweaLlng Gut bloaLed, Lender, cramplng, dlsLended, nausea, sensaLlon of fullness, acld reflux, hearLburn, flaLulence, belchlng, passlng gas, churnlng, palnful, lrrlLable bowel syndrome, coellac, hlaLus hernla, dlverLlcula, polyps, hemorrholds, ulcers, slugglsh, senslLlve, consLlpaLlon, dlarrhoea nands dry, cracked, eczema, sore [olnLs, puffy, cold, chllblalns, numbness, Llngllng, feel clumsy & uncoordlnaLed, poor clrculaLlon We|ght underwelghL, excesslve welghL, waLer reLenLlon, compulslve eaLlng, blnge eaLlng/drlnklng, cravlng cerLaln foods, Lnergy laLlgue, slugglsh, leLhargy, hyperacLlve, resLless, dralned, Llred Mood (please underllne your predomlnanL sLaLes - even lf Lhey confllcL) depressed, anxlous, fearful, nervous, Lense, angry, lrrlLable, aggresslve, happy, balanced, opLlmlsLlc, sad, pesslmlsLlc, Llred, can'L be boLhered, hyperacLlve, cheerful, aglLaLed, easlly upseL, Learful, [lLLery, frlghLened, exploslve, penL up, worrled, annoyed, overwhelmed, sulcldal, flucLuaLlng, mood swlngs nead headaches, mlgralne, sLlff neck, fuzzy headed, dlzzlness, poor balance, poundlng head, feellng of hangover, unexplalned paln, lnsomnla M|nd forgeLful, dlfflculLy learnlng new Lhlngs, easlly confused, dlfflculL concenLraLlng, poor memory, confuslon, poor comprehenslon, easlly frusLraLed, easlly dlsLracLed, dlfflculLy maklng declslons, poor comprehenslon, poor physlcal coordlnaLlon, sLuLLerlng or sLammerlng, slurred speech, can'L swlLch off, loss of lnLeresL ln dally llfe, fogglness, dyslexla, dyspraxla, hyperacLlve, panlc aLLacks, no moLlvaLlon neart lrregular or sklpped hearLbeaL. 8apld or poundlng hearLbeaL, chesL paln Chest frequenL colds and chesL lnfecLlons, asLhma, bronchlLls, dlagnosed hearL condlLlon, palplLaLlons, chesL dlscomforL/paln, shorL of breaLh, dlfflculLy breaLhlng, wheezlng, perslsLenL cough, nolsy breaLhlng, shorLness of breaLh, Io|nts (flngers, knees, back, shoulders eLc.) palnful, achy, lnflamed, swollen, sLlff, rheumaLlc, arLhrlLlc, achlng, sore, dlfflculLy bendlng, reduced moblllLy, unsLeadlness, slow movemenL, sLlff or llmlLed movemenL Gen|ta|s lLchy, cysLlLls, Lhrush, ulcers, warLs, herpes, groln paln, prosLaLlLls, pelvlc lnflammaLory dlsease, lmpoLence, palnful lnLercourse, vaglnal dryness, palnful or frequenL urlnaLlon, unexplalned dlscharge Na||s fraglle, dry, brlLLle, flaky, peellng, spllLLlng, hangnalls (spllL cuLlcles), rldged, spoon shaped, whlLe spoLs on more Lhan 2 nalls, horlzonLal whlLe llnes, Lhlckened or 'horny, dark nalls, pale nall bed, lnfecLed Legs & Ieet resLless legs, swollen, achlng, aLhleLe's fooL, fungal nalls, burnlng feeL, Lender heels, gouL, sclaLlca, cold feeL, Llngllng, numb, prlckllng.
Important Symptoms: lease lndlcaLe by under||n|ng lf you suffer from any of Lhe followlng sympLoms whlch may requlre addlLlonal medlcal care: perslsLenL or unexplalned paln, unexplalned bleedlng or dlscharge from nlpple, vaglna or recLum, blood ln spuLum, vomlL, urlne, sLools, breasL lumps, calf swelllng, dlfflculLy swallowlng, excesslve LhlrsL, lncreased urlnaLlon, lnablllLy Lo galn or lose welghL, loss of appeLlLe, paralysls, slurred speech, unexplalned brulslng, rash or welghL loss, black Larry sLools, palnless ulcers or flssures, bleedlng ln pregnancy CUk 1CkIC LkCSUkL _____ uo you llve, exerclse or work ln a clLy or by a busy road? _____ uo you spend a loL of Llme on busy roads? _____ uo you llve close Lo an agrlculLural area? _____ uo you smoke? lf so, how many a day? _________ _____ uo you llve or work ln a smoky aLmosphere? _____ uo you spend a loL of Llme ln fronL of a 1v or vuu? _____ uo you spend a loL of Llme on a moblle phone? _____ uo you sunbaLhe a loL? _____ Are you a frequenL flyer? _____ Are you exposed Lo chemlcals Lhrough work or hobby? _____ uo you heaL, freeze or wrap food ln plasLlcs? _____ uo you floss your LeeLh regularly? _____ Are your LeeLh fllled wlLh mercury amalgams? LA1ING nA8I1S Whlch are your favourlLe foods? _______________________ Whlch foods do you dlsllke? ___________________________ Whlch foods do you crave? ____________________________ Whlch foods would you flnd hard Lo glve up? _____________ _____ uo you caLer for a speclal dleL ln Lhe household? _____ Who does Lhe cooklng ln your household? _____ uo you avold any food for culLural/eLhlcal reasons? _____ uo you suspecL any foods don'L agree wlLh you? lf so, whlch: _______________________________________ _____ Pave you recenLly changed your dleL? Pow? ________ _____ uo you ever have eaLlng blnges? _____ WhaL do you blnge on? _____________________ _____ Pave you ever suffered from an eaLlng dlsorder? ________________________________________ _____ Are you excesslvely LhlrsLy? _____ uo you drlnk unfllLered Lap waLer? _____ uo you drlnk? lf so, whaL ls your usual alcohollc drlnk? __________________________________ _____ Pow many glasses do you drlnk per week? _____ 8oughly whaL percenLage of your food ls raw frulL and raw vegeLables (l.e. uncooked, fresh)? _____ uo you wash frulL and vegeLables before eaLlng? _____ uo you frequenLly fry or roasL food aL hlgh LemperaLures? _____ uo you regularly eaL browned or barbecued foods? _____ uo you eaL olly flsh or shellflsh more Lhan 3 x a week? _____ uo you go ouL of your way Lo avold foods conLalnlng preservaLlves or addlLlves? _____ uo you avold foods whlch conLaln sugar? _____ Pow many Leaspoons of sugar do you add Lo your food/drlnks each day? _____ uo you use salL ln your cooklng? ______________ _____ uo you add salL Lo your food? _____ Pow many cups of Lea do you drlnk each day? _____ Pow many cups of coffee do you drlnk each day? _____ Pow many packeLs of 'lnsLanL' or fasL food do you eaL each week? _____ Pow many Llmes a week do you each chocolaLe or confecLlonary? _____ uo you normally eaL whlLe rlce/flour/bread or brown? _____ Pow many sllces of bread/rolls do you eaL weekly? _____ Pow many plnLs of mllk do you drlnk ln a week? _____ Pow many Llmes weekly do you eaL red meaL (beef, pork, lamb, game)? _____ Pow many Llmes a week do you eaL whlLe meaL (poulLry, Lurkey, flsh)? CUk DIGLS1ICN uo you experlence. _____ lndlgesLlon (afLer food or beLween meals?) _____ lndlgesLlon afLer faLLy food? _____ uo you someLlmes suffer from bad breaLh _____ uo you chew your food Lhoroughly? _____ Pow many bowel movemenLs do you have ln 24 hours? _____ uo you occaslonally use anLacld LableLs? _____ Pave you noLlced any recenL change ln bowel hablL? _____ uo your sLools floaL? _____ 8owel movemenL shorLly afLer eaLlng? _____ ConsLlpaLlon or hard-Lo-pass sLools? _____ ularrhoea or 'urgency Lo go'? _____ 8lood or mucus ln sLools? _____ undlgesLed food ln sLools? _____ Cenerally lnconslsLenL bowel movemenLs? _____ lrequenL sLomach upseLs or sLomach paln? _____ llaLulence or bloaLlng? _____ nausea or vomlLlng? _____ aln beLween Lhe shoulders or under Lhe rlbs? _____ Anal lLchlng/ lrrlLaLlon? _____ 1hrush or cysLlLls? _____ Pave you ever had a sLomach upseL afLer forelgn Lravel? _____ uo any foods cause dlgesLlve problems? (whlch ones?) _____ Are your sLools pale, mld brown, dark brown, black or grey? _____ uo you eaL on Lhe move/when sLressed? _____ uo you frequenLly eaL under sLressful condlLlons or on Lhe move?
CUk LNLkG LLVLLS _____ uo you need more Lhan 8 hours sleep per nlghL? _____ ls your energy less Lhan you wanL lL Lo be? _____ uo you flnd lL dlfflculL Lo geL golng ln Lhe mornlng? _____ uo you flnd lL dlfflculL Lo concenLraLe? _____ uo you feel dlzzy or llghL-headed lf you sLand up qulckly? qulckly? _____uo you suffer from unexplalned faLlgue or llsLlessness? _____ Are you rarely wlde-awake wlLhln 20 mlnuLes of rlslng? _____ uo you need someLhlng Lo geL you golng ln Lhe mornlng, llke Lea, coffee or clgareLLe? _____ uo you feel drowsy durlng Lhe day? _____ uo you avold exerclse due Lo Llredness? _____ WhaL Llme(s) of day ls your energy lowesL? _____________________________________ _____ uo you geL dlzzy or lrrlLable lf you don'L eaL ofLen? _____ uo you use caffelne, sugar or nlcoLlne Lo keep golng?
IMMUNL S1LM CnLCk _____ Were you breasL-fed? _____ uo you geL more Lhan Lhree colds a year? _____ uo you flnd lL dlfflculL Lo shlfL an lnfecLlon (cold or oLherwlse)? _____ Are you prone Lo Lhrush or cysLlLls? _____ uo you ofLen Lake anLlbloLlcs more Lhan Lwlce a year? _____ ls Lhere a hlsLory of cancer ln your famlly? _____ Pave you ever had any growLhs or lumps blopsled? _____ uo you have an lnflammaLory dlsease such as eczema, asLhma or arLhrlLls? _________________ _____ uo you suffer from hayfever? _____ uo you suffer from allergy problems? _____ Pave you had a ma[or personal loss ln Lhe lasL year? _____ uo you have a medlcally ldenLlfled food allergy or lnLolerance?
WCMLN CNL _____ Are you pregnanL? lf so, how many weeks? _______ _____ Are you Lrylng Lo become pregnanL? _____ Are you breasL-feedlng aL presenL? _____ Pow many chlldren have you had? _____ Pave you had problems wlLh ferLlllLy? _____ Pave you ever had a mlscarrlage? _____ WhaL conLracepLlon do you use? _____ Are you sLlll mensLruaLlng? _____ Are you or have you been on P81? _____ Are your perlods regular? _____ Any bleedlng or spoLLlng ln beLween? _____ Are your perlods parLlcularly heavy or palnful? _____ uo you suffer from CCS, flbrolds, endomeLrlosls? _____ Any known genlLo-urlnary condlLlons? _____ Are you happy wlLh your sex drlve?
MLN CNL _______ uo you experlence mood swlngs or depresslon? _______ Loss of sex drlve? _______ Loss of moLlvaLlon and drlve? _______ Any known genlLo-urlnary condlLlons? _______ lerLlllLy problems? _______ roblems achlevlng or malnLalnlng an erecLlon? _______ lrequenL or dlfflculL urlnaLlon? _______ rosLaLe problems _______ Wake aL nlghL Lo urlnaLe _______ ulfflculL Lo sLarL or sLop urlne sLream _______ aln or burnlng when urlnaLlng
nLAL1n CAkL kCVIDLkS ls Lhls your flrsL vlslL Lo a nuLrlLlonal 1heraplsL?
Pow dld you flnd ouL abouL me?
C's name
Address:
hone:
Are any oLher LheraplsLs/cllnlcs lnvolved ln your care? lease llsL:
l have dlsclosed all Lhe relevanL lnformaLlon appllcable Lo Lhls consulLaLlon and my healLh sLaLus aL Lhls polnL ln Llme. l consenL for Lhe lnformaLlon provlded Lo be used by my nuLrlLlonal 1heraplsL and for my LheraplsL Lo llalse wlLh approprlaLe healLh professlonals.
Slgned_______________________ uaLe _____________
CUk kCU1INL lease record your rouLlne across 2 work or week days and 1 weekend/day off. Day 1 Day 2 Day off Wake up t|me
Get up t|me
Work day start t|me
Work day breaks (tota| t|me)
Work day end t|me
1|me spent trave|||ng
1|me spent exerc|s|ng
1ype of exerc|se
Lxerc|se t|me of day
1|me spent re|ax|ng
1ype of re|axat|on
Cther |e|sure act|v|ty
Cther rout|ne
Lnergy |ow t|me
Cvera|| mood
Go to bed t|me
Go to s|eep t|me
Un|nterrupted s|eep? ?/n
?/n ?/n
lease choose 2 falrly Lyplcal week days and a weekend or 'day off' and record as much as you can abouL your eaLlng, sleep and lelsure paLLerns on Lhe page below. lease glve as much lnformaLlon as posslble - home cooked or noL, brand names, fresh, packaged, whole, reflned, organlc eLc. Lo help your nuLrlLlonal LheraplsL Lo bulld an accuraLe plcLure of your llfe D a y
C f f
1 | m e s
1 | m e s
1 | m e s
1 | m e s
_ _ _
c o f f e e s .
n u m b e r
o f
s u g a r s / c u p
_ _ _
_ _ _
n o r m a l
L e a s .
n u m b e r
o f
s u g a r s / c u p
_ _ _
_ _ _
g r e e n /
h e r b a l
L e a
_ _ _
f l z z y
d r l n k s / c o r d l a l
_ _ _
u n l L s
o f
a l c o h o l
_ _ _
g l a s s e s
o f
w a L e r
o L h e r
d r l n k s
_ _ _ _ _ _ _ _ _ _ _ _ _
W e e k
d a y
2
1 | m e s
1 | m e s
1 | m e s
1 | m e s
_ _ _
c o f f e e s .
n u m b e r
o f
s u g a r s / c u p
_ _ _
_ _ _
n o r m a l
L e a s .
n u m b e r
o f
s u g a r s / c u p
_ _ _
_ _ _
g r e e n /
h e r b a l
L e a
_ _ _
f l z z y
d r l n k s / c o r d l a l
_ _ _
u n l L s
o f
a l c o h o l
_ _ _
g l a s s e s
o f
w a L e r
o L h e r
d r l n k s
_ _ _ _ _ _ _ _ _ _ _ _ _
W e e k
d a y
1
1 | m e s
1 | m e s
1 | m e
1 | m e s
_ _ _
c o f f e e s .
n u m b e r
o f
s u g a r s / c u p
_ _ _
_ _ _
n o r m a l
L e a s .
n u m b e r
o f
s u g a r s / c u p
_ _ _
_ _ _
g r e e n /
h e r b a l
L e a
_ _ _
f l z z y
d r l n k s / c o r d l a l
_ _ _
u n l L s
o f
a l c o h o l
_ _ _
g l a s s e s
o f
w a L e r
o L h e r
d r l n k s
_ _ _ _ _ _ _ _ _ _ _ _ _
8 r e a k f a s t
L u n c h
D | n n e r
S n a c k s
D r | n k s
1erms of Lngagement Nutr|t|ona| 1herap|st and C||ent
What |s Nutr|t|ona| 1herapy? nuLrlLlonal 1herapy (n1) ls Lhe appllcaLlon of nuLrlLlon sclence ln Lhe promoLlon of healLh, peak performance and lndlvldual care. nuLrlLlonal Lherapy pracLlLloners use a wlde range of Lools Lo assess and ldenLlfy poLenLlal nuLrlLlonal lmbalances and undersLand how Lhese may conLrlbuLe Lo an lndlvldual's sympLoms and healLh concerns. n1 ls recognlsed as a complemenLary medlclne and ls relevanL for lndlvlduals wlLh chronlc condlLlons, as well as Lhose looklng for supporL Lo enhance Lhelr healLh and wellbelng.
racLlLloners conslder each lndlvldual Lo be unlque and recommend personallsed nuLrlLlon and llfesLyle programmes raLher Lhan a 'one slze flLs all' approach. racLlLloners never recommend nuLrlLlonal Lherapy as a replacemenL for medlcal advlce and always refer any cllenL wlLh 'red flag' slgns or sympLoms Lo Lhelr medlcal professlonal. 1hey wlll also frequenLly work alongslde a medlcal professlonal and wlll communlcaLe wlLh oLher healLhcare professlonals lnvolved ln Lhe cllenL's care.
1he Nutr|t|ona| 1herap|st (N1) requests that the C||ent notes the fo||ow|ng - - 1he degree of beneflL obLalnable from nuLrlLlonal 1herapy may vary beLween cllenLs wlLh slmllar healLh problems and followlng a slmllar nuLrlLlonal 1herapy programme.
- nuLrlLlonal advlce wlll be Lallored Lo supporL healLh condlLlons and/or healLh concerns ldenLlfled and agreed beLween boLh parLles.
- nuLrlLlonal LheraplsLs are noL permlLLed Lo dlagnose, or clalm Lo LreaL, medlcal condlLlons.
- nuLrlLlonal advlce ls noL a subsLlLuLe for professlonal medlcal advlce and/or LreaLmenL.
- SLandards of professlonal pracLlce ln nuLrlLlonal 1herapy are governed by Lhe 8An1 Code of rofesslonal racLlce.
1he C||ent understands and agrees to the fo||ow|ng ?ou are responslble for conLacLlng your C abouL any healLh concerns.
- l glve permlsslon for you conLacL my C regardlng any agreed aspecLs of my case: LS NC
- lf you are recelvlng LreaLmenL from your C, or any oLher medlcal provlder, you should Lell hlm/her abouL any nuLrlLlonal sLraLegy provlded by a nuLrlLlonal LheraplsL. 1hls ls necessary because of any posslble reacLlon beLween medlcaLlon and Lhe nuLrlLlonal programme.
- lL ls lmporLanL LhaL you Lell your nuLrlLlonal LheraplsL abouL any medlcal dlagnosls, medlcaLlon, herbal medlclne, or food supplemenLs, you are Laklng as Lhls may affecL Lhe nuLrlLlonal programme.
- lf you are unclear abouL Lhe agreed nuLrlLlonal Lherapy programme/food supplemenL doses/Llme perlod, you should conLacL your nuLrlLlonal LheraplsL prompLly for clarlflcaLlon.
- ?ou musL conLacL your nuLrlLlonal LheraplsL should you wlsh Lo conLlnue any speclfled supplemenL programme for longer Lhan Lhe orlglnal agreed perlod, Lo avold any poLenLlal adverse reacLlons.
- 8ecordlng consulLaLlons uslng any form of elecLronlc medla ls noL allowed wlLhouL Lhe wrlLLen permlsslon of boLh Lhe nuLrlLlonal 1heraplsL and Lhe CllenL. We understand the above and agree that our profess|ona| re|at|onsh|p w||| be based on the content of th|s document. We dec|are that a|| the |nformat|on we share dur|ng th|s profess|ona| re|at|onsh|p |s, to the best of our know|edge, true and correct.