VOUCHERS:

£5 off subsequent herbalism or massage for every referral you send my way.  

You recommend a friend and you both benefit.                                                       e.g. herbal revisits £10 to £5. Massage reduced to £35.

£5 off if you come prepared. (Initial consultation only) Bring answers to the questions in purple text below. This helps me and means you are prepared. Take this information to your doctor too as its helpful for them as well.

FORMS FOR MASSAGE AND HERBAL MEDICINE

QUICKY FORM

Name

Address

AGE                            Date of Birth

Doctor and Surgery address

Allergies?

Past Medical History                                                                              (including childhood illnesses, hospital visits, GP visits in last year, major life events, family health issues).

What drugs, medications and supplements are you taking?

WHEN DID YOUR SYMPTOMS START?

ANY PATTERNS TO YOUR SYMPTOMS?

WHAT MAKES IT BETTER/ WORSE?

Rate the level of your current problems/ symptoms:  

0 (as good as it can be)         to         6 (as bad as it can be).

problem 1________________________   good     0   1   2   3   4   5   6     bad

problem 2________________________   good     0   1   2   3   4   5   6     bad

problem 3________________________   good     0   1   2   3   4   5   6     bad

This Space is for Questions to ask during consultation:

Q

Q

Q

Thanks (remember £5 off initial consultation with this info filled in)

FOOD DIARY

I have found that people can create their own food diaries better than filling in pre made forms. I do have one that can be emailed to you or photocopied if you want it. Food can link with mood, symptoms so the suggested categories below allow for this diary to be used for all sorts of causal factors. Please use the numbers from 0 (as good as it can be) to 6 (as bad as it can be).