List
Current Health Problems and Medication (list the doctors diagnoses if you
have them and the type of tests used to confirm the diagnosis, list also
tests which have come up clear - I don't need details of test results just
conclusions in your own words): |
|
|
List Significant Medical History
(Operations and year performed; Hospitalisation and reason; Major Medical
Illnesses eg Glandular Fever, Hepatitis, Meningitis, Pneumonia etc and your
age at the time; Blood Family medical trends eg Heart Problems, Stroke,
Rheumatism, Diabetes, Cancer etc): |
|
|
Resistance to Common Viruses - Immunity
in General: |
|
|
Description of your dietary, fluid intake: |
|
|
Habits like smoking/ drinking: : |
|
|
Description of bowel and bladder patterns: |
|
|
Menstrual Cycle Patterns (pain, regularity, flow, affect
of the Pill on the cycle, fertility, menopausal symptoms etc): |
|
|
Circulation Issues (eg Varicosity, Bruising, Cold
Extremities, Muscular Cramping, Blood Pressure, Postural Vertigo, Pins and
Needles): |
|
|
Occupational or Relationship Stresses or
Circumstances (which you have noticed have had an impact on your physical
and emotional wellbeing)
: |
|
|
Physical and Emotional Energy
Levels and Vitality (your normal pattern and your current pattern): |
|
|
Any other information or comments (feel free to
expand at any length on issues, co-incidences, patterns or your own
intuitive feelings about any aspects of your life and circumstances which
you suspect have or have had an effect on your health and wellbeing)
: |
|
|
|
