Introduction Session Health Form

Introduction Session Health FOrm

Congratulations on taking the first steps towards improving your health and wellbeing and becoming the healthiest version of you.

To make the most of the time we have in your introduction call please complete this form at least 24 hours prior to your call. This means that we can spend more time talking about your health issue in detail.

I look forward to speaking with you soon.

Name

First Name

Last Name

Email Address

Phone

Country

(###)

###

####

Country

Sex

Date of Birth

YYYY

What is your preferred communication method for our call?

e.g Skype, I send a direct link to a conference call or Facetime (if in Australia)…

What is your main health issue/complaint?

How long have you had this health issue?

What treatments have you tried for this health issue? i.e. medication, chiropractor, naturopath, changing diet

Have you had any testing regarding this health issue? i.e. blood tests, stool test,

Is there anything that might prevent you from completing treatment protocols or testing?

Introduction Session Health FOrm

Mikaela Mason Nutrition

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