Consultation
Please be as honest as you can in your responses. We need to know your medical concerns, history and your current medications & supplements before we can make any product recommendations.

IMPORTANT: All information disclosed will be treated with the highest level of confidentiality.

Thank you

Email address *
Your Name and Surname *
Your answer
Your Contact Number *
Please include the dialling code and a time that is convenient for us to contact you during business hours?
Your answer
Today's Date *
Your answer
Your Age *
Your answer
Your Weight *
Your answer
Conditions and Symptoms *
In full - please leave nothing out
Your answer
Current Medication *
Please include the full name of the medication / supplement / homeopathic remedy etc. Please include the dosage, how often you take it and how long it takes to have an effect on your symptoms.
Your answer
Blood Tests? *
Have you had blood tests for this condition? If so please make sure to provide us with a copy of the results.
Are you a Smoker? *
Have you had blood tests for this condition? If so please make sure to provide us with a copy of the results.
What do you do for a living? *
Your answer
What are your stress levels like? *
no stress
crazy stressed
How well do you sleep? *
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Do you exercise regularly? *
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What is your lifestyle like? *
Please tell us a little more about your routine and your daily meal plan.
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Anything else we should know? *
Your answer
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