Interdisiplinary Question

Interdisciplinary Triage Questionnaire:

Here’s a 14 question quick screen so we can best support you from where you are to where you want to go. Don’t think too hard about the answers, just answer the best fit quickly – this should take 11 minutes or less. This is not your health screen or clinical notes or anything to be judged, it merely allows us to send you the relevant material and put you in touch with the relevant modality or practitioner/s to delve deeper and more personally into your health and provide treatment or solutions if possible. The purpose of this is to allow us to hep you and for you and us to track your progress to make sure were supporting you the best and most efficiently way we can. Too often in alternative care people plug away for ages without results – the interdisciplinary model makes sure we maximise the chance of you experiencing your life as fully as you want.

Name(Required)

Email(Required)

Phone

From the dropdown box please indicate what you’re primary reason for contacting us was:(Required)

Environment

Question 1: Calibration question for our graph(Required)

1. I function well in my primary role/s (parent/worker/athlete) but I feel my health is not fully supporting me

2. My life is largely defined by my health and wellbeing limitations currently and right now I’m not able to function well in my chosen role/s

Question 2: Environment Part 1 – What water do you drink mostly(Required)

1. Kangen or I live on a spring (and drink from it)

2. Imported Spring water/restructured water for example MEA water devices

3. Reverse Osmosis (even with re-mineralisation) or other non-structuring filter for example carbon filters, BRITTA, fridge filters, whole house Chlorine filters, Ceramic filters and Zip taps

4. Tap, carbonated 2L or LESS

5. Tap, Carbonated, 2L or more

Question 3: Environment Part 2 – What sort of light environment do you live in(Required)

1. I see screens for LESS than 1hr per day and I block Blue light after dark/I see the sunrise/ I’m in the sun most of the day without sunglasses/screen/IF FOR A CHILD: my child never sees screens at all.

2. I see the sunrise and I mitigate blue light in the day and night by glasses/IF FOR A CHILD: my child never sees screens in the morning or the night and sees them for less than 1 hr total per day

3. I see the sunrise but I’m on screens fairly often without mitigation, especially after dark/IF. OR I have completed a course (8 weeks) of RED LIGHT therapy and Infra Red Sauna under the instruction of pH clinic guidelines.

4. my screen time is greater than 2hrs per day across all screen without mitigation and I don’t spend much time in the sun/I have plenty of lights on in my house after dark, I check my phone/email/news in the morning /FOR A CHILD: my child sees screens throughout the day but never after dark

5. I wear sunglasses/I check my phone in the morning before the sunrise/I have LED or screens on after dark/I don’t see the sun much in the day/my screen time is more than 3hrs per day/IF FOR A CHILD: my children see screens (phones/iPad/tablets/TV) in the morning or evening AND after dark)

Question 4: What’s your Environmental Radiation exposure like?(Required)

1. I live off grid with no reception and my electricity source/battery is away from my house.

2. I have no WIFI in my dwelling/I do not live anywhere near a cell tower, RF tower, substation/my bedrooms have been checked by a trifield meter or equivalent and have little to no EMF fields present/I always have my phone on airplane mode in the night/I have EMF blocking shielding on my phone/I have no smart meters on my home or smart devices in my home (smart fridge, TV etc that are connected to Bluetooth) or I have them in a faraday cage

3. I am conscious of EMFs and adopt most but not all of the points in the top tier of this section

4. I haven’t really considered this before but am interested in finding out more

5. I have WIFI on all the time/Bluetooth headphones/contactable phones near me constantly/I live near cell towers or substations/I have GPO's (power points) near my head when I sleep/live above the ground floor in my dwelling

Mind

Question 6: What mindset describes you most of the time(Required)

1. I believe that my intelligence, abilities, and talents are malleable traits that I can apply myself to grow and improve significantly with time, effort and application.

2. I believe that I can make a difference to my intelligence, abilities, and talents through applied effort, but the change is going to be limited.

3. I believe that my intelligence, abilities, and talents are fixed traits that, even with effort and application, will not change overtime.

Question 7: Regulation(Required)

1. I naturally manage my emotional state well and remain calm and predictably stable in response to life’s challenges.

2. I have tools that I am confident using to manage my emotional state and am able to return with some application to calm and confidence most of the time in response to life’s challenges.

3. I don’t always get it right, but I have tools that I am learning to use that help me manage my emotional state and remain, or easily return to, calm in response to life’s challenges

4. I know there are tools to help me manage my emotional state and remain calm but I find it hard to apply them when most in need.

5. I don’t see the point in trying to manage my emotional state because nothing seems to work for me when life presents challenges.

Question 8: What best describes your world view?(Required)

1. I feel safe in this world that is my creation. The world is an expression of light and love and I fully trust the unfolding of my life

2. I create my reality and am mostly living in flow but there are a few things that I know I’m attached to that I’m interested in bringing awareness to unlock even more trust and joy

3. I believe that mostly I generate the things that feel good to me but there are some things that are simply outside my control

4. I am mostly ok but I have a significant amount of trauma in my past that keeps holding me back from living fully right now

5. It feels like the world is conspiring against me- bad things just keep happening to me and I’d be ok if that all stopped or went away or my fortunes changed

Lifestyle

Question 9: What answer best describes my Energy and my Sleep?(Required)

1. I have plenty of energy to last all day and all that I like to do in the day/I wake up refreshed and excited about the upcoming day/I find it easy to fall asleep and I stay asleep all night/I tape my mouth at night or nose breath naturally

2. I mostly have solid energy all day/I wake up refreshed and I sleep all night and fall asleep easily

3. I start off with good energy but I feel pretty tired by the afternoon - I drink coffee to start my day and I have a drink (alcohol) some nights of the week to help me unwind. I mostly sleep well but don’t wake up refreshed and maybe wake once a night

4. I wake up groggy and un-refreshed. I take multiple stimulants per day to maintain function and I crave sugar in the afternoon and alcohol in the evening. My sleep is haphazard and I wake up at least one time per night

5. I am never rested in the morning, I don’t sleep well or at all (waking more that 2x per night and/or I find it difficult to fall asleep) and I use stimulants and alcohol and or sleep medication (including melatonin) or medication/supplements to assist sleep or calmness/i have sleep apnoea and a CPAP machine

Question 10: Which answer best describes your perceived state of your PHYSICAL body(Required)

1. I have full function in my entire body all the time/ I approach all physical pursuits with trust, confidence and respect but not hesitation

2. I mostly live fully in my body, rarely limited by anything physical. I very seldom feel that I cannot do what I want with my body

3. I am currently ok but I have regular flare ups of one thing or another or I am stiff, feel like I’m lacking function that restricts my comfort or confidence in my body when attempting physical pursuits

4. I am often in pain or stiff and I am confident that my body cannot do many things so im limited to living a conservative physical existence

5. I am always or mostly in pain or live with limitations and I have no trust in my body's ability to perform many physical pursuits.

Question 11: What best describes your physical routine?(Required)

1. I have a balanced and nourishing physical routine (between 4-6 movement sessions per week of diverse nature and output (i.e. some are restorative and function driven and some are strenuous to me and conditioning orientated)

2. I am an athlete with complex periodisation models in place that have comprehensive recovery modalities in place and a full lime support network

3. I have a physical training aspect to my week but it's mostly the same thing (i.e. yoga or Pilates) and I train between 2-4x per week

4. I am an athlete training more than 6x per week and I do the same or similar training for extended periods of time in the year

5. I do nothing specifically for my physical body

Food/supplements/medication and Digestion:

Question 12: What best describes your Gut function/How your digestion or Stomach area feels?(Required)

1. My digestion is reliable and smooth all of the time. I never experience bloating or pain and even though I can digest pretty much anything I chose a path that optimises my gut health and me general wellbeing

2. Most of the time my digestion is great but I avoid certain things that I know puts it out of balance for a short while

3. If I don’t eat a certain way (i.e. avoiding certain foods like Gluten/dairy etc) my stomach goes haywire and its just not worth it for me

4. I have tried pretty much everything but cannot seem to get a handle on what makes my digestion regular and comfortable - most of the time it's unreliable or volatile

5. My gut health is constantly bothering me in some capacity (elimination/discomfort/volatility etc) and its really blocking my ability to enjoy a full life

Question 13: What best describes your Food/Nutrition philosophy/practices?(Required)

1. I eat very consciously but without rigidity in my dogma - I am open to adjusting my philosophy when new information comes to light and I am conscious of: seasonal variations, organic or biodynamic farming, sourcing of food with respect to shops/markets, preparation of food, gratitude around food, eating in the light only, sharing food with friends/family, how foods respond to my feeling of energy and ethics. i have a sound or professional understanding of nutrients/digestion/absorbability.

2. I am very passionate about and don’t budge on certain aspects of how I eat for example (but not an exhaustive list): quality of oils the foods prepared in, carnivore/vegan/raw/keto/pescatarian/low carb etc, only organic or equivalent. I am following a plan currently from someone that i trust and it seems to be working

3.I live by the motto of "everything in moderation" and I try to be conscious when I can about what I eat and from where but I’m not too stressed about it if there’s a resistant force present (cost/convenience/bulk/travel lots etc). I am currently following or have previously followed a plan of eating that didn’t really work for me how I’d hoped.

4. I would eat better but I can’t afford it/don’t feel comfortable or don’t have time to cook or prepare the food I want to eat or I try for periods but then "fall of the wagon" for periods as well.

5. convenience and cost are my main motivators, I feel guilty or otherwise bad about where/what I eat/ I eat from "chains" or food courts often

Question 14: Medication(Required)

1. I believe I have no need for medication

2. I prefer to manage my situation with supplements and herbals but I’m not thriving yet

3. I refuse to take medication because I don’t agree with it/the industry

4. I take 1-2 over the counter or prescribed medications consistently OR periodically

5. I take more than 2 over the counter or prescribed medications consistently OR periodically

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Total Score