Follow-Up Form This follow-up form helps us to gather information to best serve you during your follow-up consultation.Name Have your symptoms changed since your last consultation Have your symptoms changed since your last consultation Yes NoAt what degree have your symptoms improvedAt what degree have your symptoms improved1-34-78-10 At what degree have your symptoms declined At what degree have your symptoms declined 1-34-78-10 Have you taken your supplements this week as prescribed?Have you taken your supplements this week as prescribed?Yes NoHave you added or changed the dose of any doctor's medication since your last consultation?Have you added or changed the dose of any doctor's medication since your last consultation?Yes NoWhat medication was added or changed?Blood pressure (optional) Weight (optional)Bowel MotionsBowel MotionsNormalConstipationDiarrhoeaStress levels this weekStress levels this week0-2 Chilled3-5 Some stress6-7 Stressed 8-9 High stress 10 Stressed out Water per day Water per day 0 litre1-2 litre2-3 litres3 litresCoffee per day Coffee per day 01 cup per day2 cups per day 3 cups per day Tea per day Tea per day 01 cup per day2 cups per day 3 cups per day Alcohol per week Alcohol per week 01 standard glass 2-3 standard glasses3 standard glasses Exercise session per week Exercise session per week 01-22-45 Sleep hours per night, on averageSleep hours per night, on average3-44-56-78 General comments about your health Send
