SCOT T COLL INS NATUROPATH W W W . S C O T T C O L L I N S . C O M . A U
W E L L N E S S A S S E S S M E N T Q U E S T I O N N A I R E Congratulations on wanting to explore your health and become the real healthy vibrant you. What you should note, is that this questionnaire is not intended for diagnostic purposes, nor does it replace the need to consult with a health professional. It is a tool that promotes you thinking about your health and your body over a wide range of areas. Having an understanding of your body, knowing how your body works and knowing what is normal is an important part of proactive health care. The aim of a naturopathic health consultation is to identify the dietary and lifestyle factors that ultimately impact upon your health. The naturopath’s intention is also to provide education that enables you to become more self aware and empowered in regards to your health. The following questionnaire will take approximately 20 minutes to complete, and if you’re not sure about an area move on to the next section. Once you have completed the questionnaire proceed to add up all the scores. You will quickly see the priority areas requiring more attention, which will be discusses at your appointment.
Remember this is only a guide and is NOT or is it a substitute for a MEDICAL DIAGNOSIS.
Our Team are qualified Australian Naturopathic practitioners who use nutrition, herbal medicine and diet therapy, in assisting clients to reach their health goals. The naturopath will asses clients individual health needs via an in depth thorough consultation, in conjunction with the comprehensive health appraisal. It would be appreciated if you can complete the form prior your appointment or arriving 20 minutes early to allow time to complete the form. We look forward to working with you to achieve your health goals and help set the stage for a happier and healthy life. Yours in Health and Happiness Scott Collins BHSc, Adv Dip HSc Naturopathy
33 PEAK AVENUE MAIN BEACH Q, 4217 PHONE 5526 4955 E: [email protected]
HA
Q M
etag
enic
s P
rod
uct
Gu
ide
- C
om
pre
hen
sive
(P
age
1)
IGASTROINTESTINAL(Detoxification
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nefic
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A.
HY
PO
AC
IDIT
Y
A
cute
:
Met
ages
t 1-
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blet
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2 to
1 h
our
afte
r m
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Ch
ron
ic:
D
iges
tone
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3 ta
blet
s be
fore
mea
ls
B.
SM
AL
L IN
TE
ST
INE
/PA
NC
RE
AS
A
zeo-
Pan
gen
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blet
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ith m
eals
or
Tr
ipha
la (
IT)
1-2
tabl
ets
befo
re m
eals
Ultr
a F
lora
1
caps
ule
thre
e tim
es a
day
bef
ore
mea
ls
C.
HY
PE
RA
CID
ITY
U
pper
G.I.
1-
2 ta
blet
s be
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h m
eal
Glu
tage
nics
1
serv
e th
ree
times
a d
ay
D.
CO
LO
N
Par
ex
2 ta
blet
s th
ree
times
a d
ay
U
ltra
Pro
biop
lex
2 te
aspo
ons
thre
e tim
es a
day
&
/or
Gas
troG
uard
AG
1
teas
poon
thre
e tim
es a
day
Ultr
a F
lora
1
caps
ule
thre
e tim
es a
day
or
P
robe
x C
apsu
les
1 ca
psul
e th
ree
times
a d
ay
II
DE
TOX
ME
TAB
OLI
SM
A.
LIV
ER
T
herm
o P
hase
Det
ox
1 se
rve
twic
e da
ily
or
Ultr
aCle
ar P
LUS
1
serv
e tw
ice
daily
Phy
to P
ro
1-3
tabl
ets
twic
e da
ily
S
yste
mic
Det
ox (
Phe
nolic
) 5
drop
s th
ree
times
a d
ay a
fter
mea
ls
GA
LL
BL
AD
DE
R
Li
poge
n 1
tabl
et th
ree
times
a d
ay
H
YP
OT
HY
RO
ID
Ene
rgen
ics
2-4
tabl
ets
thre
e tim
es a
day
aw
ay fr
om m
eals
Thy
roTo
ne
1 ta
blet
1-2
tim
es a
day
with
mea
ls
Ty
ro P
lus
(Phe
nolic
) 5
drop
s th
ree
times
a d
ay a
fter
mea
ls
III
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UN
EF
UN
CT
ION
A.
HY
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AD
RE
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L
C
rotic
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6 1-
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blet
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ily
A
dren
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tabl
et th
ree
times
a d
ay
P
heno
l 1
5 dr
ops
thre
e tim
es a
day
afte
r m
eals
B.
HY
PO
IMM
UN
ITY
(In
fect
ion
) (
Th
1)
Cor
iolu
s/G
rifol
a (I
T)
1-2
ml t
hree
tim
es a
day
And
ro N
K
1-2
tabl
ets
thre
e tim
es a
day
C-U
ltras
corb
II P
owde
r 1
teas
poon
thre
e tim
es a
day
&
/or
Ara
bino
Gua
rd
1 te
aspo
on th
ree
times
a d
ay
C.
HY
PE
RIM
MU
NIT
Y (
Alle
rgy)
(T
H2)
Lu
teol
Plu
s (I
T)
1 ta
blet
thre
e tim
es a
day
Imm
unoc
are
1 ta
blet
thre
e tim
es a
day
Oxy
geni
cs
1-2
tabl
ets
thre
e tim
es a
day
D.
HY
PE
RIM
MU
NIT
Y (
TH
1)
Le
ucos
tat (
IT)
2 ca
psul
es tw
ice
daily
Imm
unoc
are
1 ta
blet
thre
e tim
es a
day
Car
trin
5-
10 m
l thr
ee ti
mes
a d
ay
IV
CA
RD
IOV
AS
CU
LAR
A.
AN
AE
MIA
H
igh
Pot
ency
Iron
& C
ofac
tors
1 ta
blet
twic
e a
day
B
. H
YP
ER
TE
NS
ION
Vas
cula
r S
uppo
rt
1
heap
ed te
aspo
on tw
ice
daily
bef
ore
food
Hig
h Po
tenc
y Ta
urin
e, G
lyci
ne a
nd
2
teas
poon
s tw
ice
daily
M
agne
sium
for C
ardi
ovas
cula
r Hea
lth
Hig
h A
bsor
ptio
n C
oenz
yme
Q10
1 ca
psul
e th
ree
times
a d
ay a
fter
mea
ls
U
ltra
Pur
e E
PA/D
HA
liqu
id
1
teas
poon
1-2
tim
es d
aily
C.
HE
ALT
HY
HE
AR
T
M
etac
ard
Inte
nsiv
e C
are
2-
3 ta
blet
s th
ree
times
a d
ay
B
ioQ
60
1
caps
ule
thre
e tim
es d
aily
afte
r m
eals
Car
dioX
2 te
aspo
ons
twic
e da
ily
D.
CIR
CU
LA
TIO
N
Sca
veng
er P
lus
Sel
eniu
m
1-
2 ca
psul
es tw
ice
daily
Met
acar
d In
tens
ive
Car
e
2-3
tabl
ets
thre
e tim
es a
day
DM
G li
quid
2-5
ml t
wic
e da
ily
M
eta
EPA
/DH
A
1-
2 ca
psul
es th
ree
times
a d
ay
V
GLU
CO
SE
TO
LER
AN
CE
A.
HY
PO
GLY
CA
EM
IA
G
luco
-Tol
eran
ce F
acto
rs
1-
2 ta
blet
s th
ree
times
a d
ay
F
ibro
plex
Plu
s
2 te
aspo
ons
twic
e da
ily
In
sulin
(P
heno
lic)
or
N
euro
stat
(P
heno
lic)
5
drop
s th
ree
times
a d
ay a
fter
mea
ls
B.
HY
PE
RG
LYC
AE
MIA
Res
ist-
X
2
tabl
ets
twic
e da
ily
Lipo
ic A
cid
1
tabl
et tw
ice
daily
Ultr
aGly
cem
X
1
serv
e tw
ice
daily
VI
LUN
GS
B
ronc
ho T
one
(IT
)
3-4
tabl
ets
thre
e tim
es a
day
bef
ore
mea
ls
B
ronc
ho E
ze (
Phe
nolic
)
5-10
dro
ps th
ree
times
a d
ay
B
reat
he E
asy
for
Kid
s
1 /2 -1
sco
op tw
ice
daily
with
mea
ls
VII
K
IDN
EY
/B
LAD
DE
R
R
enox
yl
1
tabl
et th
ree
times
a d
ay
U
ropl
ex
3-
5 ta
blet
s th
ree
times
a d
ay
VII
IM
ALE
A.
PR
OS
TAT
E (
Ch
eck
Zin
c Ta
lly T
est)
P
alm
etto
Plu
s
1-2
tabl
ets
thre
e tim
es d
aily
Vas
cula
r S
uppo
rt
1
heap
ed te
aspo
on tw
ice
daily
bef
ore
food
Test
oste
rone
(P
heno
lic)
5
drop
s th
ree
times
a d
ay a
fter
mea
ls
B.
RE
PR
OD
UC
TIO
N (
Ch
eck
Zin
c Ta
lly T
est)
Trib
ulus
Syn
ergy
2 ta
blet
s th
ree
times
a d
ay
M
AC
A P
lus
(IT
)
2 ta
blet
s th
ree
times
a d
ay
O
xyP
ro
1
tabl
et tw
ice
daily
with
mea
ls
IX
FEM
ALE
A.
PM
S
Fem
me
Pre
men
stru
al
1-
2 ta
blet
s on
ris
ing
Car
dioX
2 te
aspo
ons
twic
e da
ily
H
orm
ocrin
e (P
heno
lic)
5
drop
s th
ree
times
a d
ay a
fter
mea
ls
B
. O
VAR
IAN
DY
SF
UN
CT
ION
(C
hec
k Z
inc
Tally
Tes
t)
E
stro
Fact
ors
1
caps
ule
thre
e tim
es a
day
Fib
ropl
ex P
lus
2
teas
poon
s tw
ice
daily
Hor
moc
rine
(Phe
nolic
)
5 dr
ops
thre
e tim
es a
day
afte
r m
eals
C.
ME
NS
TR
UA
L IR
RE
GU
LA
RIT
IES
F
emm
e P
rem
enst
rual
1-2
tabl
ets
on r
isin
g
E
stro
Fact
ors
(IT
)
1 ca
psul
e th
ree
times
a d
ay
O
meg
a E
FA
1-
2 ca
psul
es th
ree
times
a d
ay
H
orm
ocrin
e (P
heno
lic)
5
drop
s th
ree
times
a d
ay a
fter
mea
ls
(IT
) -
Inno
vativ
e T
hera
pies
pro
duct
s ar
e on
ly a
vaila
ble
in Q
ld. a
nd o
nly
thro
ugh
the
Pat
ient
Ord
er S
yste
m.
HA
Q M
etag
enic
s P
rod
uct
Gu
ide
- C
om
pre
hen
sive
(P
age
2)
IX
FEMALE
con
t.
D.
FIB
RO
CY
ST
IC
F
emm
e P
rem
enst
rual
1-
2 ta
blet
s on
ris
ing
O
meg
a E
FA
1-2
caps
ules
thre
e tim
es d
aily
M
eta
I-3-
C (
IT)
2 ca
psul
es tw
ice
daily
with
food
H
orm
ocrin
e (P
heno
lic)
5 dr
ops
thre
e tim
es a
day
afte
r m
eals
E.
ME
NO
PAU
SE
Fem
me
Oes
trop
lex
1-2
tabl
ets
twic
e da
ily
Est
roFa
ctor
s (I
T)
1 ca
psul
e th
ree
times
a d
ay
Hor
moc
rine
(Phe
nolic
) 5
drop
s th
ree
times
a d
ay a
fter
mea
ls
X
MU
SC
ULO
SK
ELE
TAL
A.
BO
NE
ST
RE
NG
TH
(C
hec
k Z
inc
Tally
Tes
t)
Cal
citit
e H
i-Str
engt
h 1
tabl
et th
ree
times
a d
ay
or
O
steo
Plu
s 1-
2 ta
blet
s tw
ice
daily
B.
MU
SC
LE
A
cute
:
Fib
ropl
ex P
lus
2 te
aspo
ons
twic
e da
ily
Sup
er Z
GS
S
pray
are
a 3-
4 tim
es a
day
C
hro
nic
:
Myo
plex
2
tabl
ets
thre
e tim
es a
day
C.
CO
NN
EC
TIV
E T
ISS
UE
Col
lage
nics
2
tabl
ets
thre
e tim
es a
day
or
G
luco
sam
ine
Inte
nsiv
e C
are
1 ta
blet
2-3
tim
es a
day
or
Car
trin
5
ml i
n 10
0-20
0 m
l of w
ater
or j
uice
twic
e da
ily
Infla
vano
id In
tens
ive
Car
e 2-
3 ta
blet
s th
ree
times
a d
ay
or
K
apre
x 1
tabl
et th
ree
times
a d
ay
D.
NE
UR
OL
OG
ICA
L
B
rahm
i Ton
e 1-
2 ta
blet
s tw
ice
daily
N
euro
Pro
(IT
) 1
teas
poon
twic
e da
ily
Pho
spha
tidyl
serin
e 2
caps
ules
twic
e da
ily
XI
MO
OD
AN
DB
EH
AV
IOU
R A
. S
TR
ES
S
N
euro
Cal
m
1 ta
blet
thre
e tim
es a
day
B
rahm
i Ton
e 1-
2 ta
blet
s tw
ice
daily
S
tres
s E
ze (
Phe
nolic
) 5
drop
s th
ree
times
a d
ay a
fter
mea
ls
B.
AN
XIE
TY
Neu
roC
alm
2
tabl
ets
thre
e tim
es a
day
or
Vat
a To
ne
2 ta
blet
s th
ree
times
a d
ay
Car
dioX
2
teas
poon
s tw
ice
daily
N
euro
II (
Phe
nolic
) 5
drop
s th
ree
times
a d
ay a
fter
mea
ls
C.
DE
PR
ES
SIO
N
H
ydro
xytr
ypto
phan
Com
plex
1
caps
ule
1-2
times
a d
ay
Her
bal &
Nut
ritio
nal S
uppo
rt fo
r
Adr
enal
Hea
lth
1 ta
blet
thre
e tim
es a
day
G
inkg
o/B
acop
a C
ompl
ex
1-2
tabl
ets
twic
e da
ily
Par
asym
path
etic
Sup
port
5-
10 d
rops
thre
e tim
es a
day
afte
r m
eals
D.
INS
OM
NIA
Pro
xan
(IT
) 1
caps
ule
twic
e da
ily
Myo
plex
2
tabl
ets
thre
e tim
es a
day
N
euro
Cal
m
2-3
tabl
ets
befo
re b
ed
E.
CO
NC
EN
TR
AT
ION
Neu
ro C
are
for
Kid
s 1 /
2 -
2 sc
oops
twic
e da
ily
AD
D/A
DH
D C
ompl
ex (
Phe
nolic
) 5-
10 d
rops
thre
e tim
es a
day
afte
r m
eals
Z
inc
Drin
k 2
ml i
n 25
0 m
l wat
er 1
-2 ti
mes
a d
ay
Om
ega
Car
e fo
r K
ids
1 /2
- 1
teas
poon
twic
e da
ily
Pho
spha
tidyl
serin
e 2
caps
ules
twic
e da
ily
Spe
cific
Phe
nolic
s m
ay b
e in
dica
ted
for
food
alle
rgie
s/ch
emic
al s
ensi
tiviti
es.
XII
D
ER
MA
TOLO
GY
/S
KIN
Z
inc
Drin
k 2
ml i
n 20
0 m
l wat
er 1
-2 ti
mes
a d
ay
Oxy
geni
cs
1-2
tabl
ets
daily
D
erm
a C
lean
se
Use
as
a bo
dy w
ash,
in s
itz b
ath
or a
s
so
ak b
ath
(20
min
s)
A.
EC
ZE
MA
Lute
ol P
lus
(IT
) 1
tabl
et th
ree
times
a d
ay
Imm
unoc
are
1 ta
blet
thre
e tim
es a
day
U
ltra
EPA
Liq
uid
1-2
teas
poon
s da
ily
B.
PS
OR
IAS
IS
Le
ucos
tat (
IT)
2 ca
psul
es tw
ice
daily
Im
mun
ocar
e 1
tabl
et th
ree
times
a d
ay
Ultr
a E
PA L
iqui
d 1-
2 te
aspo
ons
daily
XII
ID
ETO
XS
TE
P 1
- A
nti
mic
rob
ial t
her
apy
(2-6
wee
ks)
P
arex
2-
3 ta
blet
s tw
ice
daily
bef
ore
food
or
Cos
tat
1-2
tabl
ets
twic
e da
ily b
efor
e fo
od
Ultr
a P
robi
ople
x 2
teas
poon
s th
ree
times
a d
ay
Am
oeba
&/o
r S
plee
noge
n 5-
10 d
rops
thr
ee ti
mes
a d
ay a
fter
mea
ls
ST
EP
2 -
Gu
t R
ein
ocu
lati
on
an
d S
up
po
rt (
2 w
eeks
)
Ultr
a F
lora
Plu
s 1 /
2 to
1 te
aspo
ons
in w
ater
thre
e tim
es a
day
G
luta
geni
cs
1-2
teas
poon
s th
ree
times
a d
ay
Gas
troA
G
1-2
teas
poon
s th
ree
times
a d
ay
ST
EP
3 -
Liv
er (
2-4
wee
ks)
T
herm
o P
hase
Det
ox
1 se
rve
thre
e tim
es a
day
or
Ultr
a C
lear
PLU
S
1 se
rve
thre
e tim
es a
day
P
hyto
Pro
2-
3 ta
blet
s tw
ice
daily
Li
poge
n 1
tabl
et th
ree
times
a d
ay b
efor
e m
eals
S
yste
mic
Det
ox
5-10
dro
ps th
ree
times
a d
ay a
fter
mea
ls
X
IV
OV
ER
WE
IGH
T-Usethe
KetoS
ystem
K
etos
lim
1 se
rve
two
times
a d
ay
Ket
o B
ar
1 /2
bar
as a
sna
ck b
etw
een
mea
ls
Met
a O
il 1-
2 te
aspo
ons
twic
e da
ily
Fib
ropl
ex P
lus
2 te
aspo
ons
twic
e da
ily
XV
W
ELL
NE
SS
/M
AIN
TE
NA
NC
E
G
EN
ER
AL
PO
PU
LA
TIO
N
Mul
tigen
ics
Phy
to P
lus
1 ta
blet
twic
e da
ily
Met
a E
PA/D
HA
1
caps
ule
twic
e da
ily
Phy
to P
ro
1 ta
blet
twic
e da
ily
F
EM
AL
E O
VE
R 5
0 Y
EA
RS
OF
AG
E
F
emm
e E
ssen
tials
1
tabl
et o
nce
a da
y
Cal
citit
e H
i-Str
engt
h 1-
2 ta
blet
s tw
ice
daily
E
stro
Fact
ors
1 ca
psul
e th
ree
times
a d
ay
M
AL
E O
VE
R 5
0 Y
EA
RS
OF
AG
E
M
ultig
enic
s P
hyto
Plu
s 1
tabl
et tw
ice
daily
P
alm
etto
Plu
s 1-
2 ta
blet
s tw
ice
daily
P
RE
CO
NC
EP
TIO
N C
AR
E
Zin
c Ta
lly
Che
ck Z
inc
leve
ls, s
uppl
emen
t if n
eede
d
Fem
me
Ess
entia
ls
1-2
tabl
ets
twic
e da
ily
Fib
ropl
ex P
lus
2 te
aspo
ons
twic
e da
ily
P
RE
GN
AN
T /
BR
EA
ST
FE
ED
ING
Fem
me
Ess
entia
ls
1 ta
blet
twic
e da
ily
Met
a E
PA/D
HA
Liq
uid
1-2
teas
poon
s da
ily
Hem
agen
ics
Inte
nsiv
e C
are
1
tabl
et th
ree
times
a d
ay
(if r
equi
red)
(IT
) -
Inno
vativ
e T
hera
pies
pro
duct
s ar
e on
ly a
vaila
ble
in Q
ld. a
nd o
nly
thro
ugh
the
Pat
ient
Ord
er S
yste
m.
MET1568 - 12/05