Health Questionnaire

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Pre Treatment Health Questionnaire

Please complete the form below prior to your first colonic irrigation health consultation.

The required information is securely and directly sent by email to Gedling Colonics.

You can now save your form part way for completion later. Please note, cookies are required to use this feature.

All information is handled in the strictest confidence.

Gedling Colonics' Pre-Treatment Health Questionnaire

Step 1 of 11 - About You

  • Please enter the age of any children you have, separated by a comma if more than 1