PERSONAL INFORMATION - STRICTLY CONFIDENTIAL

We will require you to complete a questionnaire prior to you attending your first appointment.


You can download the form by clicking HERE.


The form is in Microsoft Word format.

Some tips before coming to a clinic

  

1.  Please keep hydrated. I suggest drinking at least 1 pint of water in the 2 hours prior to coming. 


2. Do not drink coffee on the day that you come for a treatment or eat any pork products.


3. It would be appreciated if you could include a passport-like head photo when you send in your input form. If this is not possible I can take a quick photo when you come in. Please note that this is not obligatory – it is just helpful for me. I will explain why when we meet.


4. Please wear some loose clothing. When testing with the bicom Bioresonance equipment, we may need to place a flexible electrode on to different parts of your body – usually your abdomen. 


5. We require 24 hours notice for a cancellation or postponement. 

DIET DIARY INSTRUCTIONS

  

It is important to keep an accurate record of your usual and food and beverage intake as part of your treatment plan.

Please complete the Diet Diary for 3 consecutive days including one weekend day.

 

Do NOT change your eating behaviour at this time, as the purpose of this food record is to analyse your present eating habits.


Record information as soon as possible after food /drink has been consumed.


Describe the food/drink as accurately as possible (e.g. milk – what kind; full fat; semi-skimmed; skimmed; soya: toast – white; wholegrain; buttered: chicken – fried; roasted: coffee – decaf with or without sugar [how much sugar]).


Record the amount of each food/drink as accurately as possible using standard measures (e.g. teaspoon; ½ cup; 50 g).

Include any added item. (e.g. tea with 1 teaspoon honey; 100 g potatoes with 2 teaspoon butter etc).


Record ALL drinks and quantities, including water; tea; coffee; sports drinks; fizzy/diet drinks etc.

Include any addition comments about you eating habits (e.g. craving sweet; skipped meals and why; mention if meal was at a restaurant etc).


Please make a note of all bowel movements and whether regular, firm or loose etc. 


To Download Diary Form click HERE