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Naturopath Scott Cousland's Health Survey

Welcome. Using this survey is optional. If you prefer we can go over these during our consultation.

Completing this survey now will free up time during our scheduled appointment
(or allow us to cover the basics in less time, so you can get on with your busy day).
2. Gender
This question requires a valid number format.
4. Height in feet
5. Height in inches
This question requires a valid number format.
This question requires a valid number format.
8. How often if your sleep interrupted?(for any reason - bladder, thirsty, children, pets or unknown)
9. How many full meals do you eat per day? *This question is required.
10. Do you have at least one Bowel Movement daily? *This question is required.
This question requires a valid number format.
12. What is the first thing you drink after getting out of bed? *This question is required.
( based on 8 oz glass ) This question requires a valid number format.
14. How would you describe your use of Salt?
15. Which type of Salt do you mostly use?
16. How do you get Iodine in your Daily diet?
17. I exercise (anything from Walking to Weight Lifting)
18. How I use Chiropractic Care
19. What types of Surgery have you had? *This question is required.
This question requires a valid number format.
21. Type of Work Performed
0%
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