Natural Lore Client Group Intake Form

If you have applied, been approved and already have a login - please do NOT use this form you can access and update your details here

You have been directed here by a Consultant or trusted friend – Welcome.

Please complete the below questionnaire to help determine the most appropriate protocol for you. This is an essential requirement for an initial consultation to assist in providing the correct on-going support for your health and wellness goals. This form does not have a "save" function so please ensure you have at least 10 minutes to complete the form in one sitting, or have essential information handy elsewhere on your computer for you to copy and paste as needed.

At the completion of the form please click the "I am not a robot" box. Once you have clicked this box and the "Submit" button, your form will be sent to your preferred Consultant. You will receive a welcome email notification that contains important information about your consultation and a link to Frequently Asked Questions (FAQ's) that may be helpful for you and your support team. If you do not have a preferred Consultant or Wellness Clinic, you will be contacted within 48 hours to discuss your individual needs.

Please save the email and password you have selected for your account as this will be your access to on-line product ordering and support resources. Please note that your application will be approved at the time of consultation which will then grant you full access to the site and NOT before.

If you are completing this form on behalf of a child, another person or an animal, please ensure your contact details are noted in the "Carers" section and only complete questions that apply to the relevant persons situation.

If you have any questions or issues with this form please contact This email address is being protected from spambots. You need JavaScript enabled to view it. and our support team will be in contact within 24 hours.

Medical History

Please tick your issue from the following conditions listed below .. If you have something other to what’s listed, please write a detailed description of your condition below, including all relevant information. Please include any recent reports of tests done when you send this form back or prior to a consultation . PLEASE BE VERY SPECIFIC WITH ANY OFFICIAL DIAGNOSIS:
Indicate your CURRENT levels of the below issues with a rating of 1 - 10 (1 being lowest and 10 being highest). Use how you would normally feel as the reference point:

Personal History and Situation

We endeavour to be as thorough and supportive to your individual needs as possible. The following are a series of questions which help us to determine where you are in relation to your own well-being and healing. Your honesty in answering the questions are of benefit to YOU by assisting the practitioners to determine the most advantageous holistic approach for you– so please sit quietly with each question before answering. Your answers are private and confidential;
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