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Online Pre-Consultation Ten-Part Questionnaire

Easy Print

Thank you for booking a medical herbalist consultation with Brett Elliott.
To get the best out of our time together please complete the questionnaire below.

Name

Phone

SOME BASIC QUESTIONS ABOUT YOUR METABOLISM

Any blood sugar issues

Blood Pressure

Fluid Retention

Fatigue

Cholesterol Levels

Body Weight

Do you suffer with Gout?

Do you suffer with Kidney Stones?

Do you suffer with Gall Stones?

SOME BASIC QUESTIONS ABOUT YOUR DIGESTION

Do you suffer with Indigestion

Do you suffer with Acid Reflux (Heartburn)?

Do you suffer with Constipation

Do you suffer with Bloating?

Do you suffer with Gas (wind)?

Do you suffer with Candida (or Thrush)?

Do you suffer with Irritable Bowel Syndrome?

Do you suffer with Celiac Disease?

Do you suffer with Crohn's Disease?

Do you suffer with Parasites?

Do you suffer with Stomach Ulcers?

A COUPLE OF QUESTIONS ABOUT YOUR SKIN

Do you suffer with Excema?

Do you suffer with Psoriasis?

Do you suffer with Boils?

Any other skin condition you want to describe?

Do you suffer with Acne?

JUST A COUPLE OF BASIC QUESTIONS ABOUT IMMUNITY AND INFLAMMATION

Do you suffer with any Allergies? (if so please list)

Do you suffer with Arthritis?

Do you suffer with Asthma?

Do you suffer with a sinus congestion?

Do you suffer with a lung congestion?

Do you suffer with a cough?

Any other immune disorder you can describe?

SOME QUICK QUESTIONS ABOUT YOUR STRESS LEVELS

Do you suffer with Headaches?

Do you suffer with Insomnia?

Do you suffer with Depression?

Do you suffer with Confusion or Memory loss?

Do you suffer with Palpitations?

How would you rate your stress levels?

A QUICK CHECK ON YOUR DIET HABITS

HOW OFTEN DO YOU EAT THESE ITEMS?

Alcohol

Tobacco (or Vape)

Beef & Lamb (red meat)

Burgers or Fish 'n Chips

Bread, Pastry, Cake (Baked goods)

Cheddar Cheese

Chocolate or other sweets

Standard Coffee or Tea

Energy Drinks

Other sugary drinks

Ice Cream or other desserts

Margarine

Nuts

Seeds

Potato chips

Any other junk food you want to mention?

WHAT MEDICATIONS YOU ARE TAKING?

Please list any prescription drugs you are taking

Please list any supplements or herbs you are taking

Please list any other recreational drugs you are taking (this is kept confidential)

A COUPLE OF LIFESTYLE QUESTIONS

How often do you go walking?

How often do you go running?

How often do you do garden work?

How often do you do a gym workout?

Do you have a physical job?

How often do you participate in sports?

ADD ANY EXTRA DETAILS ABOUT YOUR GOALS

Outline any other specific details of your health concern

What's your number one priority with this consultation?

More To Explore

Reduce High Blood Pressure Naturally

A very common diagnosis received at your Doctors visit is High Blood Pressure but what causes it and how can we reverse it without using drugs with all their nasty side effects?

Brett Elliott 3 months ago

Metabolic Syndrome Explained Causes & Solutions

Metabolic Syndrome Defined and Explained

Metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes and pre-diabetes, abdominal obesity, high cholesterol, and high blood pressure.

Brett Elliott 5 months ago

Phone

New Zealand FreePhone
0800 555 556
Worldwide
+647-5442863

Address

Head Office
26 Fantail Drive, Maungatapu, Tauranga 3112 New Zealand

AU Office
Rotorua St, Caulfield South
3162, Victoria

Connect With Us

DISCLAIMER:
Statements on this website have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.

Product images are for illustrative purposes only and may differ slightly from the actual item.

Results will vary in time frame and intensity from person to person. All testimonials and reviews are authentic and submitted from actual Ultimate Herbal Health customers. We offer a 100% satisfaction guarantee. Please see our terms and conditions for details. Please visit our live chat, use the contact us page or phone numbers above if you have any questions.

WARNING:
There may be detox effects including temporary nausea, headaches, bloating or bowel discomfort. If these symptoms persist stop the program for 24 hours and resume at a lower dose. If you have any health condition or are taking medications please consult your physician before use.

Ultimate Herbal Health products should not be used by pregnant or nursing women, by children under 12, or by anyone with a serious medical condition. Do not use Ultimate Herbal Health products if you are allergic to any of the ingredients. If you are taking any medications or have any serious health condition please consult with a healthcare professional before using Ultimate Herbal Health products.

QUALITY:
The products on this website are herbal dietary supplements and contain no pharmaceuticals or synthetic chemical ingredients. Our products are manufactured under license in New Zealand within a GMP registered facility and meet all the food safety standards of New Zealand. Ultimate Herbal Health products comply with the dietary supplement laws in New Zealand.

We make no claim to cure, prevent or treat any disease. None of the Statements on this website have been approved by the FDA or any other health authority.

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