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Changing your nutrition and lifestyle can seem daunting, particularly when you are feeling tired, overwhelmed and unwell.

Schedule a complimentary 10 minute conversation with our Patient Care Coordinator, to discuss your current circumstances and how we can support you.

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Jacinta O'Connor
Certified GAPS & MINDD Practitioner
Name *
Stooling, digestive issues, urination issues, pain, energy levels, sleep, mood, menstruation issues (if applicable) etc
Stooling, digestive issues, urination issues, pain, energy levels, sleep, mood, menstruation issues (if applicable) etc
Please include the drug name, frequency of dosing (e.g. once daily, twice daily) and dose amount (e.g. 10mg)
Please include the name of the supplement, frequency of dosing and amount of each dose (e.g one scoop, one capsule/tablet)
Which vaccines have you had since 2020?
Viral History
Please tick the box of any virus you have experienced
What exercise do you do each week?
What mindfulness / meditation practices, joyful activities have you introduced recently?
Thank you for taking the time to complete this form. If there is any additional information you wish to share, you are welcome to do so in this space. Please email test results, such as recent blood work to jacinta@jacintaoconnor.com

Thank you for taking the time to complete this worksheet. This will assist in streamlining our appointment, allowing us to focus on what needs to be put in place to improve your health.