Hello sunshine,

Please fill the Health History Form below. Once I receive it, I will contact you on the email you provided and we will schedule a FREE 30 minutes call to decide how to proceed.

Let me know if you have any questions.

Kind regards,

Soraya ☀️

HEALTH HISTORY MEN

PERSONAL INFORMATION
in cm
in kg
in kg
in kg
Would you like your weight to be different?
SOCIAL INFORMATION
HEALTH INFORMATION
Do you wake up at night?
Any serious illnesses/hospitalizations/injuries?
Any pain, stiffness or swelling?
Constipation/Diarrhea/Gas?
Allergies or sensitivities?
WOMEN'S HEALTH
Are your periods regular?
Painful or symptomatic?
Reached or approaching menopause?
Do you experience yeast infections or urinary tract infections?
MEDICAL INFORMATION
Do you take any supplements or medications?
Any healers, helpers, or therapies with which you are involved?
FOOD INFORMATION

What is your food like these days?

Will family and/or friends be supportive of your desire to make food and/or lifestyle changes?
Do you cook?
in %
Do you crave sugar, coffee, cigarettes, or have any major addictions?
ADDITIONAL COMMENTS