Book a Consultation Clinic Booking Form What are your contact detailsName Phone*Date of Birth*Email Enter Email Confirm Email Occupation*Who would you like to see?*Simone Reddington - Thursday, Friday, alternate weekendsSarka Horvathova - Tuesday, Thursday, Friday, alternate weekendsMelody Mortiaux - Tuesday, Wednesday, Thursday, alternate weekendsI don't have a preferencePlease see Our Practitioners page to get to know our practitioners and their days and specialist areas of health. Not all of or practitioners are available in clinic every day, but we will try and arrange for you to see the practitioner of your choice.Select a Consultation type*Creme dela CremeWarrant of FitnessQuick FixLive Blood AnalysisLive Blood Analysis with RecommendationsLive Blood Analysis with full consultationDiet AnalysisDigestion ClinicAllergy ClinicCardiovascular ClinicSleep ClinicStress ClinicDiabetes ClinicImmune ClinicMusculoskeletal ClinicSkin ClinicMens ClinicWomens ClinicChildrens ClinicOur bookings are designed around a basic menu and depend on your needs at the time. Please select the option you feel best suits your wellness goals.Preferred date* Please provide us with a preferred date for your appointment. We will ring you to confirm or change the date or time.Please select a time* : HH MM AM PM We will try to fit you in if possible and will call you to confirm or change the time if needed.Have you been to a G.P regarding this health problem*YesNoWhich GPCan we contact the GPYesNoWere you referred to us?Please let us know who you were referred byAre you pregnant or planning on becoming pregnant in the near future?*Yes I am pregnantYes I am planning for the near futureI am of childbearing age and not using contraceptionNoN/ATell us a bit about your conditionWhat's your current health status?*Please provide a bit of detail about your current health and your health complaint(s) What are your symptoms?*What symptoms are you experiencing and for how long have you been experiencing them?Do you feel that stress has played a part in your symptoms?*Stress in the form of ongoing or major stress prior to or at the advent of your symptoms e.g. relationship stress, work pressure, life stressMedical History*Please tell us a little about hour health background including: allergies, accidents, childhood illness, injury, recent illnessFamily History (if known)*Tell us a little about any relevant family history related to your conditionWhat Medication are you taking*Please tell us about your history of antibiotic use*We would like to know approximately how many times you have used antibiotics in your life and also how recently. Include any side effects you experienced.What Natural Medicines or Supplements are you taking*Health Goals*What are your health goals? Please let us know what you would like us to help you with the most. We will discuss these goals further at your appointment.Today's Date* We will be in touch shortly to confirm your appointment date and time. Thanks – The Apothecary Team.