Emergency Contact Details
How can we help you?
In a few words, please describe the state of your:
Smoking & Drugs
Female Clients Only
Please bring your most recent pathology result and any medical reports with you to your initial appointment.
Personal Health History
Family Health History
Please provide details for any significant health problems.
Privacy Clearance and Legal Consent
I understand that Helen Ridge is a Naturopath and not a Medical Doctor. I give my permission for my health history and records to be kept on file for the purpose of Naturopathic treatment.
I understand that all information within my file will be kept confidential at all times.
All information given within this questionnaire is a true and accurate representation of my health.