Please include any preferred pronouns if you'd like
If applicable, do you have a regular GP that you see?
If applicable, including psychologists, psychiatrists, counsellors, dieticians, gynaecologist, etc.
Please include skin, air or food allergens that give you an allergic reaction
Please include dates of each event
Please only include formal diagnoses
For example, acne, period pain, fatigue, PCOS, etc.
Go into more detail here, as much or as little as you'd like, regarding your signs, symptoms, pain, limitations, quality of life, etc
Please include dosage, who prescribed these, and how long you've been on these for
Please include dosage and who prescribed or recommended these
Please let me know a brief overview of your average daily diet, if there are any specific diets or protocols you follow, any foods you avoid, cultural preferences that impact your diet, ethical diet preferences, etc. This is important as what you consume directly relates to your health & healing capacity
