Health History & Lifestyle
Help me understand your health background, current experience, and what you've already tried.
Before You Begin This Section
This page gathers your core health history so I can understand your full picture before we begin working together.
You do not need to share anything you are not comfortable with. Answer as fully as feels right for you.
Everything you share is kept private and used only to support our work together.
Informed Consent & Signature
Health History & Lifestyle
5E Capacity Check
Your Health History Form
Take your time. You can pause and return at any point.
What Happens After You Submit
Once you have completed this page, you will be taken to Page 3 — the 5E Capacity Check. This is a short scored questionnaire that helps me understand where you are right now across five key domains.
Executive
Emotional
Embodied
Energetic
Existential
Need Help or Have a Question?
If anything on this form feels unclear or you'd like to talk something through before continuing, please don't hesitate to get in touch.
Email Carolynhello@harmoniance.co.uk
