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Nutritional Health Review
WORKING FROM_SOUTHWARK

To better assist your Health Review with us, please complete the below by 17th September as fully as possible.

Full Name *

Email *

Age *

List 1-3 areas of your health and wellbeing that you would like to work on *

What things are you struggling most with right now?

How long have you been struggling with this?

What (If Anything) have you done so far to improve this?

Do you have any existing medical conditions?

Are you on any current medications?

How would you rate your current stress level *

1
2
3
4
5

How would you rate your quality of sleep

1
2
3
4
5

Thank you for filling in this questionnaire for your health review. We look forward to welcoming you!

‘Take control of your health today’

thehouseofwellbeing.co.uk

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Each health screening test is carried out by a pharmacist taking a finger prick of blood from your finger. The blood is then placed in a device or machine. The results will then be interpreted by the pharmacist and advice & guidance given. In the majority of cases the results take 10 minutes.

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