Screening Questionnaire

Before we begin working together, please complete this quick questionnaire about your health history, medications, and any symptoms you’re experiencing to ensure it’s safe for us to move forward. Your safety is my top priority.

Please answer each question honestly. Don’t worry – it doesn’t necessarily mean we can’t work together, but some symptoms may require a doctor’s approval first.

If you have any questions along the way, don’t hesitate to contact me at hello@francesnorgate.com. I’m here to help!

Please enable JavaScript in your browser to complete this form.
Name
I’d like to receive the latest updates, wellness tips, and special offers from Resync Wellness. (You can unsubscribe at any time.)
Do you have any diagnosed medical conditions?
Are you taking any prescription medication (excluding contraception, HRT, PPIs, statins and blood pressure medication)?
Are you currently working with a healthcare practitioner or awaiting results of tests?
Are you experiencing any of the following symptoms? (Please select all that apply.)
If you tick any of the boxes, please speak to your GP. I am unable to work with you at the present time but please feel free to get back in touch once your symptoms have resolved.
Are you currently pregnant, planning to become pregnant, or undertaking IVF?