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Health and Treatment Questions

What is the reason for your appointment today?

Please tell us about your health history

Please tell us about any relevant family medical history

Therapies

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Relationships

Relationship status

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Working life

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Do you have any allergies or intolerance, if yes please list

Craving?

Enhancers

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Injuries/pain

Please list any areas of your body that are sore tight or injured

Sketch which part you are concerned about. Red is very troublesome, green is disturbing, blue is has pain but negligible.

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Live Well Holistic Wellness Centre