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 asterix * are required fields.
Your Details
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? *
  • Gut

  • Microbiome

  • Liver & Elimination

  • Immunity

  • Adrenals

  • Stress

  • Toxic Load

    Please note where chemicals are referred to in this question, it is referring only to non-natural products (including cleaning products, skincare, haircare) that contain sulfates, petroleums, etc. If you use natural based products in your home already, please do not tick yes to these questions.

  • Thyroid

  • Hormones

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