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• E-mail
• The Clinic at Chester (01244) 322822
• Health Appraisal
• Telephone consultation

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HEALTH APPRAISAL

NAME:                                                 

Date:                                                   

Age:                 Sex:                

Occupation:                                          

Please list below your four main health complaints in order of importance:

Please list below any medication you are taking regularly (prescribed by your doctor or purchased over the counter):

Please list below any supplements you are taking regularly (including vitamins, minerals, herbs, homoeopathic, either purchased over the counter, or advised by a practitioner):

Open the Word document:

Health Appraisal Questionnaire - page 1

0800 980 3447

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