BEFORE YOUR SESSION

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Pre-session questionnaire

Thank you for booking. Please tell us about your current daily life and anything you would like to discuss, so we can prepare for your consultation. This takes approximately 10 minutes. Fields marked “required” must be completed; all other questions are optional.

01About you

Full name (required) Name pronunciation (optional) Date of birth (required) Occupation Address Email address (required) Phone number, including country code (required) Height (cm) Weight (kg)

02Health & medical background Medicines you currently take Previous operations Past health conditions or conditions currently being treated Family medical history (no names needed) Allergies

03Everyday habits

Alcohol Smoking Average hours of sleep Daily fluid intake Your usual meals, exercise and daily routine Marital status (optional) Do you have children? (optional)

04Your concerns & goals

Select any areas you would like to discuss.

Physical wellbeing Emotional wellbeing Appearance Relationships

Please tell us more about your concerns What would you most like to discuss? How would you like to feel six months from now?

Questions? Contact us on LINE

Before you submit