New Client Intake Form

Health Haven Gold Coast 
New Client Intake Form

Welcome to Health Haven Naturopathy, Gold Coast.

We look forward to supporting your on your health journey! After you’ve booked an appointment please take a minute to complete this New Client Intake Form.  Please do this as soon as possible, giving us as much time as possible to review your case prior to your appointment.

Welcome to Health Haven Naturopathy

Complete this form with as much detail as possible, to allow us to consider your health in the most comprehensive way. The information provided on this form is confidential and only shared with your practitioner

How can we help?

Described the primary health concern, the reason you booked an appointment. (Further down you have opportunity to provide your full health history).

Severity of Condition/s?

Has anything changed or become worse lately, and in what way? (if nothing is worse, write NO in the text box)

Are You Taking Medications and/or Supplements?

Please detail each providing dosage & how long you've been taking each one. Include pain killers, supplements, vitamins & prescribed medicines.

Do You Have Any Allergies. Intolerances or Sensitivities?

Tell Us About Your Health History

Smoking History

Recreational Drugs & Alcohol

Detail how often & how much you consume weekly.

File / Document Uploads

Use this function to attach any relevant files including blood tests, pathology results, doctor reports or health history documents The system will only allow one file to upload, please attach all documents into one file or send additional files directly to

Consent to Naturopathic Care

Naturopathic medicine is a holistic approach that assesses the whole person on physical and emotional levels and uses a combination of modalities to stimulate the body’s own capacity to heal. These may include but are not limited to diet; clinical nutrition; herbal medicine; therapeutic supplementation; lifestyle counselling; homeopathy; flower essence therapy; iridology. As with any medical treatment there can be possible health risks, including but not limited to aggravation of symptoms during the healing process, mild gastrointestinal upset, headaches, allergic reactions, etc. All care is taken to avoid any issues/symptoms during treatment but sometimes they still occur. By signing below you consent to treatment and accept any symptoms incurred because of it. In the event of reaction please contact the clinic immediately.

By checking the box below you consent and agree that you understand the above information. You consent to a consultation and subsequent naturopathic care, for as long as you are client of Health Haven. You can withdraw your consent and discontinue my naturopathic care at any time. You acknowledge that there are no guarantees regarding outcomes and accept the clinic's cancellation/fee policy.

Thank you for your time completing this form. If you have any questions or have other documentation to provide please email us at  We look forward to helping you soon!