Health Info

Please fill out the following health form 24 hours prior to our first session.
Do you often feel recently?
Your behaviour in the last few weeks?
Current Thoughts?

Before we begin our journey together, I would like to discuss something very important that will have a major impact on your ability to recover and achieve maximum improvement.


After many combined years of health and wellness consultation, I have had the opportunity to work with thousands of patients and have seen many patients achieve significant improvement while others can become frustrated and have lagged behind in their attempt to get well.


After careful review, I have discovered the reasons why some people succeed and why others fail. This questionnaire is about much more than eliminating your symptoms – it’s about choosing to live a life of vibrant health and a life you love.


I’ve  discovered that any discussion of the correct way to achieve health and stay healthy is, in actuality; a discussion of how you have lived your life up to this point and how you will live it in the future.


Therefore, to help you make significant changes in your present health, I want to ask you a few very important questions. I want you to be honest with yourself and being honest with me helps us determine a realistic starting and continuing point for you.

In order to improve your health, you will be asked to make the following changes:

  • Significantly modify your diet

  • Take several nutritional supplements each day

  • Modify your lifestyle (e.g. work demands, sleep habits)

  • Practice relaxation techniques 

  • Engage in regular exercise 

  • Have periodic check ups to assess progress

  • Invest enough time into educating yourself about the first causes of health problems and how we can reverse them through lifestyle and diet 

  • Complete all necessary online program modules and homework every week before each session

  • Book your sessions in each week in advance



I the client...


· I am seeking to consult Heidi Shannon to aid me in a finding a balanced approach to health and wellness and understand that Heidi offers a special interest in nutritional, holistic, alternative and environmental medicine.

· This means that I offer a more holistic approach to patient diagnosis and care – an approach primarily involving diet, supplementation, exercise, lifestyle and stress management & I understand that Heidi does not offer a main stream medically supported health and wellness process.

· Alive charges an agreed upon rate for retreats prior to starting the retreat and I understand and agree to this rate.


· Heidi may offer some of the recommended products for purchase including supplements and educational materials but I understand that I am not obliged at any time to purchase.

· Some of the treatment suggestions (eg nutritional or digestive supplements) offered by Heidi are considered to be outside the parameters of conventional medicine in Australia. I understand that I am to use my best judgement on what is right for me and for me only.

· Some of our treatments fall under the category of complementary or alternative medicine. These interventions are in the majority of cases supported by research evidence, and are only prescribed with utmost care.


I am attending this program of my own free will and consent and as an informed adult taking responsibility for my own health and my own actions exercise my right to discuss and choose any useful and suitable treatment(s) made available to me.

I enter into this program at my own risk. I understand Heidi Shannon takes no responsibility for injury or damages that occur during the program.

I agree to pay the invoiced fees prior to each session.

I agree to be ready for my sessions at the designated time without distractions.

I, Heidi Shannon endeavour to provide you with a high standard of professionalism and care. I look forward to guiding you on your journey to wellness and ask for your full cooperation.

Thanks for submitting! I look forward to speaking soon!