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D-Restricted Ltd:
Health Questionnaire

Please complete your 'Health Questionnaire' below. This is necessary for all appointment types.  I recommend this being completed at the same time as you book your appointment. Failure to do so may result in your appointment being delayed.
Some questions may not be wholly visible if being completed on a mobile phone or small device.

Thank you for your co-operation!

for all appointments.

C-Section Categories:
Category 1: Immediate risk to life of either mother or foetus
Category 2: Maternal or foetal compromise
Category 3: Early birth necessary
Category 4: Elective section for medical or choice reasons
Please include reason for section type/what happened?

Please tick all of the feeding methods used since birth
Is there any family history of diagnosed tongue-tie restriction?
Has your child received Vitamin K?
Have you had any previous appointments with myself for the child named above?
Additional Related Symptoms: