The Endometriosis and Fertility Clinic
Questionnaire

Nutritional Consultation

For your first visit to an Endometriosis and Fertility Clinic Nutritional Therapist you will need to complete a questionnaire. This questionnaire is used to assess your health and nutritional status and to help the nutritional therapist formulate your nutritional programme. Please be as accurate as possible in filling in the information, We work with a strictly confidential code of ethics and this information is limited in the same way as your doctors notes.

Please print off the PDF document below, complete it and bring it with you to your consultation. If you are wanting a postal/telephone appointment, then post it to:

  The Endometriosis and Fertility Clinic
56 London Road
Hailsham
East Sussex
BN27 3DD

We are working on an online version

QUESTIONNAIRE PDF Version