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Screening Questions
Would you say that you are:
Generally healthy and well both emotionally and physically?
Mildly unwell?
Significantly unwell?
If you are not generally well, what length of time have you been unwell?
Not relevant
Less than one year
Between one and five years
More than 5 years.
Do you:
take any long-term medication (including contraceptive pill)?
see a doctor for treatment for any on-going condition?
take street/recreational drugs (including alcohol dependency)?
have M.E., Chronic Fatigue or Fibromyalgia?
have a parent who has (or has had) a long-term, chronic condition or illness?
have a history of significant psychological trauma?
Do you have any history of high sensitivity (i.e. becoming unwell) with any of the following items? Please scale 0 - 3 where 3 is high sensitivity.
Prescription drugs (eg allergy to antibiotics) or recreational/street drugs (including alcohol)?
0
1
2
3
Foods (eg gluten, caffeine, sugar, dairy), chemical toxins, EMF, bites, stings, nutritional supplements?
0
1
2
3
Healing therapies and meditative practices?
0
1
2
3
Terms and Conditions, etc.