top of page

INITIAL CONSULTATION FORM

In order to understand your unique history we require all clients to have an initial consultation. 
Please fill out the information below to book. 

Your Details

Your GP details

Please add below the contact details of your GP (e.g. Name, Email, Telephone Number, Address)

​

CONSULTATION AGREEMENT

 

 

Please read these terms carefully 

​

I agree to the following conditions for the upcoming consultation with my naturopathic nutritionist:

​

  • The information I have provided/will provide via questionnaires, phone, email, in-person, or by any other means of communication is accurate to the best of my knowledge.

  • The recommendations I will receive from my naturopathic nutritionist are not a substitute for medical advice from a qualified doctor.

  • The advice I will receive from my naturopathic nutritionist is personal and applies to me only. This same advice may be ineffective or even harmful when applied to other people with different background.

  • I must communicate to my naturopathic nutritionist any changes in my medical prescriptions or treatments for the duration of my nutrition plan.

  • I must inform my naturopathic nutritionist promptly if any of my new changes in diet or lifestyle start to cause me adverse effects.

  • I understand that the advice I shall receive will not be enough to achieve my nutrition or lifestyle goals unless I follow it diligently and commit to it fully. I understand any changes in my diet and lifestyle may produce effects in my body, energy, health, and condition that are gradual in nature – not instantaneous.

  • I understand that, although my naturopathic nutritionist will endeavour to help me achieve my nutrition
    and lifestyle goals to the extent possible, the possibility exists I may not fully attain my goals due to factors outside the control of my naturopathic nutritionist.

 

 

Electronic signature 
By entering my full name I acknowledge I have read, understood and agree to the terms set out above.

     

© 2024 Innate Naturopathic Health 

bottom of page