Siobhán Shinnors – Licenced Medical Herbalist & Yoga Therapy

Note: All records are strictly confidential under the patient client confidentiality agreement
and are stored in compliance with data protection regulation.

Focus – What do you want to achieve from this consultation*
Describe your Symptoms*
Supplementation (list dose & brand)*
Allergies or Food Avoidances - List applicable

Tick the boxes that best describe your symptoms
Personal Past Medical History - HIGHLIGHTS*
Sleep - Average sleeping hours*
Stress Level*

Attach IRIDOLOGY photo here (only if paid for at checkout).
The file size must be less than 25 MB and the allowed file types are ( PDF, JPG & BMP )

Mind / Body
Diet – Give 2 Examples of each meal. Be as honest as possible. *
Time *
Examples *
Drinks - List quantity per day/week in Liters*
Drugs - tobacco / vaping / recreational drugs *
Thank you you have completed your online consultation. A personalised nutrition plan will be emailed to you within 7 days of submitting this form including recommendations for any herbal formulas or supplements in the better health shop or online.

Important Notice 

Please do not close this tab until you see the information that the form is sent. It may take a while, but this data is important so we appreciate your patience.