Pediatric Intake Form (0 – 1 year)

Pediatric Intake Form (0-1 year)word

Pediatric Intake Form (2 – 16 years)pdf

Pediatric Intake Form (2 – 16 years)word

Adult Intake Form2


Dear Parent,

I am totally dedicated to helping your child become as vital, healthy and happy as possible and to achieve their health goals. Because of my commitment to you, our clinic is different to many other Natural Health Clinics. We use the 3-Step Appointment System. (If you just want a one-off appointment that is completely fine too.) 

All New Patients start with an Initial 50 minute appointment. After your initial appointment I will take all the information we have discussed, and your New Patient Form (above), and I will spend time researching exactly what is wrong in your child’s body, why it has gone wrong.

I will need to gather more information from tests to clarify certain biochemical pathway aberrations and to get baseline markers to enable us to monitor your child’s progress. And I will inform you of which tests are most useful following your initial appointment.

The tests I require will depend totally on the information you give me during the initial screening. In many cases they can be conducted in the privacy of your own home if urine, saliva or stool tests are required, or in a pathology collection centre if a blood sample is required. These tests give me a great deal of information about your child’s body and how they are reacting to their diet and lifestyle.

Once I have the information from your child’s tests I will finalise my research on them to then present you with a Wellness Report. This is always an insightful and fascinating report all about your child and their body. Your Wellness Report will explain to you what is happening in your child’s body, why they are feeling or acting the way they are and I will provide for you a simple and effective solution for you to correct what has gone wrong.

I am confident your child will be feeling much better in a short while.

Warm Regards,

Gabi Giacomin


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