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Your profile

Before we meet to discuss and plan your treatments it will be very useful for us to know a bit about you, and to understand what treatments you might wish to consider.

Please complete the form alongside or download the form here to complete and bring in when you come for the first consultation.

All the information you provide will be treated in absolute confidence and we will never share your details with any third party.

    Do you smoke?

    How many per day?

    Have you ever smoked?

    When did you quit? (year)

    Are you trying to lose weight?

    If so, how many pounds?

    Do you have a special diet?

    Do you have a special diet?

    Do you take regular exercise of over 20 minutes a day?

    Type of exercise

    Do you drink alcohol?

    Units per week?

    Are you pregnant?

    Are you breastfeeding?

    Please list any prescribed medication, herbal remedies or supplements that you are currently taking, or have taken in the past six months

    What is the main treatement you are considering

    Any other treatement you might consider