Questionnaire

To help us give you the most accurate and detailed consultation, please complete our pre-consultation questionnaire.














VEGA Testing is a fast, effective and non-invasive form of testing.

You should not be VEGA Tested if:

1) You are pregnant

2) You have severe heart arrhythmia or blockages

3) You have a pacemaker

4) You have labile circulation or a weak heart

Prior to VEGA Testing you should:

1) Not wear makeup or moisturisers to the test.

2) Not put on any creams, lotions, oils or nail polish on your feet/hands for the 3 days prior to the test.

3) Not wear nylon pantyhose to the test.

4) Not drink coffee or tea less than 2 hours before the test.

5) Not eat less than 1 hour before the test (unless diabetic).

 

Constipation
Diarrhoea
Excessive Flatulence

Bloating
Cramping
Mucus/slimy

Blood
Very Smelly
Pain

 

PMT
Heavy Bleeding
Menopausal Issues

Sore swollen Breast
Irregular Cycle
Hot Flushes

Reduced Libido
Vaginal Discharge
Hysterectomy

Painful periods
Clots with Periods
Fluid retention

Ovarian cyst
Endometriosis
Abnormal Pap Smear

STI’s
Genital Warts
Thrush/Itchiness

 

Prostate Issues
Reduced Sex Drive
Pain In Testes/Groin

Erectile Dysfunction
Excessive Sex Drive
Difficulty Urinating

Anxiety
Eating disorder
Weight Problems

High Cholesterol
Depression
Bloating after eating

Sinus Problems
High Blood Pressure
Low Mood

Stomach pain/Cramp
Asthma
Chest Pain

Excessive Worry
Tired in Afternoon
Eczema

Cold Hands/Feet
Low Self Esteem
Sugar Cravings

Anaemia Iron/B12
Haemorrhoids
Emotional/Mental Stress

Wake up to toilet
Thyroid issues
HIV/Aids

Physical/Traumatic Stress
Muscle Cramps
Diabetes Type1/2

Kidney disease
Toxic Exposure
Numbness/Tingling

Low Immunity
Cancer
Loss of appetite

Back/shoulder pain
Bad Breath
Hepatitis/Liver issue

Excessive appetite
Headaches
Bad Body Odour

Gallbladder issue

INFORMED CONSENT FOR NATUROPATHIC CONSULTATION WITH PETER BALOGH

I consent to consultation with Peter Balogh and understand it may include the prescription of remedies.

I have, following consultation, consideration and discussion, agreed to undergo this therapy. I am fully aware that the services I wish to receive are those of a holistic nature and do not serve as a substitute for professional medical advice, examination, diagnosis or treatment.

I acknowledge I have given my personal details for the holistic providers use. I understand that my information is protected and I give my consent for Peter Balogh to store and use my details. I understand that if I have been untruthful with my details or have failed to give enough relevant information any treatment could be adversely affected.

The therapist and or the VEGA Test does not claim to cure or to diagnose any medical condition in the same regard as a physician, as their opinion is that of a holistic, complementary and alternative therapist and their professional opinions, advice, examinations and recommendations do NOT constitute the medical advice of a doctor/physician.