M.H.A Pre-Consultation Form

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1 is Manageable , 5 is Severe

Natural (vaginal birth, no medical intervention or treatments)Vaginal Birth (with medical intervention and/or treatment)Planned C-SectionEmergency C-SectionAssisted Vaginal Birth (forceps delivery or vaccum extraction)Home BirthWater Birth

In order to gain a better viewing of who you are and how best I can assist you on your plant medicine journey, I need something from you.

Remember this a no judgement, strictly confidential form so please be transparent when completing each section. Help me help you!

It is a requirement that persons seeking to use my services provide a brief but truthful insight into what a typical day in your life looks like. This will include details that involve your work life, family, regular commitments, social and leisure activities etc.

Why do I need this information?

This information will enable me to pinpoint any areas that might be allowing for disruption within the body, as it is our everyday routines and choices that have the greatest impacts on our livelihood.

More often its the small things that we often overlook, that over time cause us the biggest distress and imbalances. Busy lifestyle leaves minimal time for rest, and conscious fueling. So with this in mind tell me what you day looks like.

1 is Low, 5 is High

Less than 1000ml1000 - 2000ml2000 - 3000mlOver 3000ml

Is key for making sure our bodies stay in a flow state.

When you engage in regular movement you provide the necessary support for multiple bodily systems (for example the lymphatic and circulatory systems).

Regular movement helps to strengthen our physical body, ensuring adaptability, whilst encouraging personal evolution on a physical and cellular level. And the best bit is that movement doesn’t have to be strenuous, it doesn't have to be specific just allowing your body to move and flow is enough.

However if you are looking for somewhere to start activities such as Tai Chi, Qi Gong, Yoga, stretching, walking, dance, all help to maintain and encourage flow.

Are you moving enough? Let's find out..

EverydayFew times per weekFew times a monthNever

Plant medicine is a unique experience that is delivered and administered according to the client and the spirit and/or qualification of the herbal worker.

My Role as a Plant medicine worker is to provide clients with knowledge and herbal offerings that support and allign to your (the client) individual journey (needs) - be it to maintain wellness or bring the body back into ease, through your openness and my connect we will work together to find what's right for you.

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