Get Food Intolerance Questionnaire - The Maple Tree Clinic

This guide provides user-friendly and detailed instructions on how to complete the Food Intolerance Questionnaire provided by The Maple Tree Clinic. Follow these steps to ensure a smooth and effective submission process.

Follow the steps to successfully complete the questionnaire online.

1. Use the ‘Get Form’ button to access the Food Intolerance Questionnaire and open it in the editor.
2. Begin by entering your personal details, including your name, address, email address, and contact information. Indicate whether you would like to receive promotional information.
3. Provide your occupation and date of birth to help the clinic understand your background.
4. List your doctor’s name and address to establish your primary healthcare provider.
5. Explain how you heard about The Maple Tree Clinic. This will assist in their marketing efforts.
6. Detail your current health problems. For each problem, note how long it has persisted and whether you have consulted your doctor about it.
7. Reflect on any past illnesses within the last ten years, along with any surgeries you have undergone.
8. Include information about any medications, supplements, or creams you currently use, noting when you began each.
9. If you have children, provide their ages and sexes.
10. Describe your usual exercise regimen and relaxation techniques to give insight into your lifestyle.
11. Detail your typical daily food and drink consumption, including breakfast, lunch, dinner, and snacks.
12. Indicate the frequency of your bowel movements and assess your sleep quality and hours.
13. Report whether you smoke and estimate your weekly alcohol consumption.
14. List any known allergies or intolerances you have or suspect.
15. Provide your blood type and, if applicable, answer the women-only questions regarding pregnancy, birth control, and menstrual health.
16. State what you aim to achieve from the food intolerance testing appointment.
17. Utilize the space provided for any additional comments or concerns that may be relevant.
18. Finally, read and sign the declaration confirming your understanding of the kinesiologists' role in your care. Include your signature and print your name to finalize the document.

Complete your Food Intolerance Questionnaire online today for a better understanding of your health!