LIFESTYLE ASSESSMENT FORM

CONFIDENTIAL

IMPORTANT

Please Note: The health information received during this consultation is for general education and is not intended to be specific medical advice. No medical care, diagnosis, or treatment is provided during this consultation. It is advisable to consult with one’s personal health care provider before implementing any lifestyle changes.

To receive a written/typed report without examination, providing detailed opinion based on information received. (fee of £75 to be paid prior to consultation). This fee includes receiving a written report outlining the recommendation to incorporate in your lifestyle.

I release MM Gospel Medical Missionary Lifestyle Counsellor’s or associated organizations from all liability. Participation in this consultation indicates acceptance of these terms.