Intake Questionnaire

The Intake Questionnaire is the first step of your assessment with the HHM Team. Please see Consultations for more information. The intake questionnaire is purchased online along with an instructional video with step-by-step instructions on how to complete the questionnaire. The questionnaire covers information regarding your personal and family medical history, your current symptoms, specific childhood events, your lifestyle, your likely exposure to toxic substances, where you are at in terms of your mental health and where you are at with respect to your ‘readiness for change’

The step-by-step instructions video created Dr’s Hale and Rodrigues is the first but critical step in your HHM assessment. Begin the process of optimising your assessment. Upon completion, our team will review your submission and contact you with any queries or further questions…

Intake Questionnaire Overview

Part 1 of the questionnaire collects your contact details and asks for an overview of the health issues you’d like addressed in the IFM Assessment.

Part 2 asks you to provide details of the conditions/illnesses, including cancers in your family (parents, siblings, grandparents, aunts, uncles and cousins).

Part 3 asks questions about your personal history from birth till the age of 20, covering psychological, medical, environmental and other factors.

Part 4 (women only) asks about your reproductive health including pregnancies.

Part 5 is a Toxic Exposure questionnaire

Part 6 asks you questions regarding your current mindset.

Part 7 explores the symptoms you are currently experiencing

Part 8 Change Readiness Assessment

Part 9 Additional Comments not otherwise covered in earlier parts of the questionnaire.

We understand this questionnaire can take time for some patients to complete. For this reason, you are able to save your progress and return at a later date to continue with the questionnaire.