Consultation Form

Please fill out this form and submit at least 3 days prior to your appointment. this form does take some time to fill in, but please take your time and fill it in full, as this will reduce time having to go through the questions in your appointment. Please be honest, I am here to help you and make appropriate recommendations. There are some questions that I appreciate are sensitive and personal, but I require the information to ensure that I modify treatments and recommendations to your scenario. Please note sub headings are idea of what to include in the free text fields, not specific lists of what to include. However, the more details you can provide, the better.