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  • Home
  • Practitioners
    • Lynette Hill
    • Kohei Iguchi
  • Services
    • Hemaview – Now Called FocuSpect
    • Naturopathy
    • Homeopathy
    • Testing
    • Health Questionnaire
    • Contact
    • Book Online
  • Shop
    • Supplements
      • Pain And Inflammation
      • Nutrition
      • Stress And Energy
      • Immune System
      • Healthy Aging
      • Digestion
      • Hair, Skin And Nails
      • Homeopathy
    • Personal Care
    • Women’s Health
    • Men’s Health
    • Children’s health
    • Home Kits
    • Courses
    • Books
  • Blog
    • Health Bites
    • Articles and Testimonials
    • ADRENAL & FATIGUE
    • ALLERGY & SENSITIVITY
    • AUTOIMMUNE DISEASES
    • CANCER
    • CHILDREN IMMUNITY & WELLNESS
    • DETOX
    • DIGESTION & GUT
    • HEALTHY AGING
    • HEART & CARDIOVASCULAR
    • HORMONES & ENDOCRINE
    • HOMEOPATHY
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Health Questionnaire

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  2. Health Questionnaire

Health Questionnaire

Please fill out the below questionnaire before your visit.
  • Date Format: DD slash MM slash YYYY
  • Emergency Contact

  • Medical History

  • Name of ProductDosage (Per Day)Start Date 
  • BrandName of ProductDosage (Per Day)Start Date 
  • Vaccinations

  • Occupations

    Please list your current and former occupations and pastimes:

  • Dental & Oral Health

  • Female Only

  • Please enter a number from 1 to 100.
  • Male

  • Stools

  • Urine

  • Weight & Metabolism

  • Exercise

  • Type of ExerciseDurationFrequency (Per Week) 
  • Diet

  • What type of foods do you typically eat from day to day?

  • WeekdayWeekend 
  • WeekdayWeekend 
  • WeekdayWeekend 
  • WeekdayWeekend 
  • Thank you for your time.

    Please note that all information provided will be strictly confidential and will not be disclosed to anyone without your permission.

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About us

We are a modern integrative Natural Medicine Practice. Our services include Naturopathy, Homeopathy , medical herbs  and Hemaview, We offer both acute and chronic care.

Lynette is available Tuesdays/Thursdays only.

Kohei is available Mondays/Wednesdays/Fridays and the 1st Saturday of each month only.

Open hours

Mon, Tue,Wed, Fri: 9 AM – 5 PM

Thur: 9 AM – 7 PM

1st Saturday of erach month ONLY: 9 AM – 1 PM

Sunday: Closed

Contact us

808 Beach Road, Browns Bay,

Auckland

New Zealand 0630

Email: health@myremedy.co.nz

Telephone: +64 9 479 1171

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