Main health problem/ complaint

Health History

General health

How much of the following would you have a week?

Do you experience any of the following? If so, please state what tends to make it worse, or when you tend to get it.

For women

Is the pain

What other symptoms do you get?

Do you experience any other health problems?

Cancellation Policy:
If you are unable to make your appointment, please advise us as early as possible. Our policy is that

• No Show fees are charged at full price
• For appointments cancelled with less than 24 hrs notice a fee of $50 will be charged for all reasons of cancelling, including emergencies, sickness, etc.
• Please note that not receiving a SMS or an email reminder will NOT be accepted as a reason for missing an appointment, so please ensure you diarise your appointment