Client Assessment


CLIENT DETAILS







Sex* :




HEALTH HISTORY

2. Indicate if you have had blood relatives with any of the following problems:

Cancer :

High blood pressure :

Diabetes :

Osteoporosis :

Heart disease :

Thyroid disorder :

High cholesterol :

PCOD :

3. Do you have complaints about any of the following?

Appetite :

Constipation :

Bleeding gums :

Diarrhea :

Bruising :

Edema :

Chewing or swallowing :

Indigestion :

Menstrual difficulties :

Sudden weight change :

Seeing in dim light :

Stress :

 
 
 

DRUG HISTORY

DIET HISTORY

 
 

4. What change would you like to make?

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