Health Appraisal Form
Your answers to this health appraisal questionnaire will assist your Practitioner in gaining information about your current symptoms and health concerns. Please answer all questions, in each section.
Circle the number which best describes the frequency of your symptoms over the previous month, or answer the yes or no questions by circling the appropriate letter.
You may note that some questions are repeated throughout the questionnaire. We would appreciate it if you can answer all questions, as this will ensure the most accurate interpretation of your results. You may however leave