New Client Questionnaire Help us get to know you better! Name *Email Address *Phone *Date Of Birth *Weight(KG) *Height (cm) *Have you been diagnosed with a medical condition? *List any current medications you are takingList any current diet supplements you are takingFamily History of illness/disease?Any allergies / sensitivities to foods or drugs?What health condition are you seeking help with?List the foods you eat on an average day?Daily cups of water you drink?Agreement *YesNoI understand that the Practitioners of Immortal Health Australia are Qualified Clinical Practitioners. As such, I know that it is my right and responsibility at any time during my treatment to seek medical counsel and diagnosis. I acknowledge that the state of my health is my own responsibility and that I am exercising my right to choose an alternative method of treatment in therapy that addresses my health in its entirety. Cancellations to bookings made within 24 hours of the appointment will incur a 100% cancellation feeSend Message [instagram-feed feed=1]
