Follow-Up Form 

This follow-up form helps us to gather information to best serve you during your follow-up consultation.

Have your symptoms changed since your last consultation

At what degree have your symptoms improved

At what degree have your symptoms declined

Have you taken your supplements this week as prescribed?

Have you added or changed the dose of any doctor's medication since your last consultation?

Bowel Motions

Stress levels this week

Water per day

Coffee per day

Tea per day

Alcohol per week

Exercise session per week

Sleep hours per night, on average