Tel: 071 966 3311 Mobile: 087 972 8044 Email: info@karunaflame.com
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Karen Stewart and Kris Zurek R.N.M.H., ITEC, SNHS, Members of Microscopy Practitioners Association, Holistic Health Therapists

Holistic Health Centre,
Cloonloo, Boyle,
Co. Sligo.

Tel: 071 966 3311
Mobile: 087 972 8044
Email: info@karunaflame.com

              
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Patient Assessment Form – Detailed

We appreciate if you take time to fill in this Patient Assessment Form (questionnaire) as precisely and truthfully as possible. It will greatly help us and you to identify hidden factors shaping your health. Together with various other screenings/tests, this information will prove to be very important to generate a synergistic view of client’s situation, prognosis and possible wellness protocols which can be tailored to your individual needs.

Please download, print and fill the form. Once filled, it needs to be sent to the address specified on the Form, prior to coming for the appointment. If you are unable to send it for whatever reason, than please bring the filled Form with you.

Patient Assessment Form (PDF) – click here for download