{"id":24466,"date":"2023-12-28T11:05:55","date_gmt":"2023-12-28T11:05:55","guid":{"rendered":"https:\/\/aqtn.ca\/questions\/?p=24466"},"modified":"2025-09-04T05:06:16","modified_gmt":"2025-09-04T05:06:16","slug":"questionnaire-de-sante-pour-naturopathes-genere-avec-un-logiciel","status":"publish","type":"post","link":"https:\/\/aqtn.ca\/questions\/association-quebec-aqtn-other-posts\/questionnaire-de-sante-pour-naturopathes-genere-avec-un-logiciel\/","title":{"rendered":"Questionnaire de sant\u00e9 pour naturopathes"},"content":{"rendered":"
\n

QUESTINONAIRE SANT\u00c9 POUR NATUROPATHES INFORMATIONS PERSONNELLES<\/h3>\n
\n
\n
\nNom et pr\u00e9nom<\/strong>:
\nDate de naissance<\/strong>:
\n(JJ\/MM\/AAAA)<\/em>
\nSexe<\/strong>:<\/p>\n

Adresse<\/strong>:
\nNum\u00e9ro de contact<\/strong>:
\nCourriel:
\n<\/strong>
\nProfession<\/strong>:
\nPersonne \u00e0 contacter en cas d’urgence<\/strong>:
\n(nom et lien de parent\u00e9)<\/em>
\n<\/div><\/div>\n

\n

\"intakeform<\/p>\n<\/div><\/div>\n<\/div>\n

INFORMATIONS SUR LA SANT\u00c9 :<\/h3>\n
\n
\n
    \n
  • <\/i> Raison principale de la visite :<\/strong>\n
      \u00a0\u2022\u00a0D\u00e9crivez vos principales pr\u00e9occupations ou sympt\u00f4mes.<\/ol>\n<\/li>\n
    1. <\/i> Ant\u00e9c\u00e9dents de la maladie actuelle :<\/strong>\n
        \u00a0\u2022\u00a0Quand vos sympt\u00f4mes ont-ils commenc\u00e9 ?<\/ol>\n<\/li>\n
      1. \n
          \u00a0\u2022\u00a0Comment ont-ils \u00e9volu\u00e9 dans le temps ?<\/ol>\n<\/li>\n
        1. <\/i> Ant\u00e9c\u00e9dents m\u00e9dicaux :<\/strong>\n
            \u00a0\u2022\u00a0Indiquez toutes les maladies chroniques ou importantes, les interventions chirurgicales ou les hospitalisations pass\u00e9es.<\/ol>\n<\/li>\n
          1. <\/i> M\u00e9dicaments et compl\u00e9ments actuels :<\/strong>\n
              \u00a0\u2022\u00a0Indiquer la posologie et la fr\u00e9quence.<\/ol>\n<\/li>\n
            1. <\/i> Allergies:<\/strong>\n
                \u00a0\u2022\u00a0Indiquer les allergies m\u00e9dicamenteuses et non m\u00e9dicamenteuses.<\/ol>\n<\/li>\n<\/ul>\n<\/div>\n

                DESCRIPTION D\u00c9TAILL\u00c9E DES SYMPT\u00d4MES :<\/h3>\n
                \n
                \n
                  \n
                • <\/i> Pour chaque sympt\u00f4me mentionn\u00e9 dans les sections “Raison principale de la visite” et “Histoire de la maladie actuelle”, demandez :<\/strong>\n
                    \u00a0\u2022\u00a0La localisation exacte du sympt\u00f4me.<\/ol>\n<\/li>\n
                  1. \n
                      \u00a0\u2022\u00a0Le caract\u00e8re de la douleur ou de la g\u00eane (aigu\u00eb, sourde, lancinante, etc.).<\/ol>\n<\/li>\n
                    1. \n
                        \u00a0\u2022\u00a0Tout facteur aggravant ou am\u00e9liorant les sympt\u00f4mes (moment de la journ\u00e9e, m\u00e9t\u00e9o, \u00e9tat \u00e9motionnel, etc.).<\/ol>\n<\/li>\n
                      1. \n
                          \u00a0\u2022\u00a0Sympt\u00f4mes associ\u00e9s (par exemple, naus\u00e9es accompagnant les maux de t\u00eate).<\/ol>\n<\/li>\n<\/ul>\n<\/div>\n

                          INFORMATIONS COMPL\u00c9MENTAIRES SUR LE MODE DE VIE :<\/h3>\n
                          \n
                          \n
                            \n
                          • <\/i> Habitudes alimentaires:<\/strong>\n
                              \u00a0\u2022\u00a0D\u00e9crivez vos repas quotidiens habituels (petit-d\u00e9jeuner, d\u00e9jeuner, d\u00eener et collations).<\/ol>\n<\/li>\n
                            1. \n
                                \u00a0\u2022\u00a0Avez-vous des restrictions ou des pr\u00e9f\u00e9rences alimentaires (v\u00e9g\u00e9tarien, v\u00e9g\u00e9talien, sans gluten, etc.) ?<\/ol>\n<\/li>\n
                              1. \n
                                  \u00a0\u2022\u00a0Avez-vous des probl\u00e8mes de digestion (ballonnements, indigestion, constipation, etc.) ?<\/ol>\n<\/li>\n<\/ul>\n<\/div>\n
                                  \n
                                    \n
                                  • <\/i> Exercice et activit\u00e9 physique :<\/strong>\n
                                      \u00a0\u2022\u00a0D\u00e9taillez le type (a\u00e9robic, musculation, yoga, etc.), la dur\u00e9e et la fr\u00e9quence de votre programme d’exercices.), la dur\u00e9e et la fr\u00e9quence de vos exercices.<\/ol>\n<\/li>\n
                                    1. \n
                                        \u00a0\u2022\u00a0Ressentez-vous une g\u00eane ou une douleur pendant l’activit\u00e9 physique ?<\/ol>\n<\/li>\n<\/ul>\n<\/div>\n
                                        \n
                                          \n
                                        • <\/i> Habitudes de sommeil:<\/strong>\n
                                            \u00a0\u2022\u00a0D\u00e9taillez votre routine du coucher et votre environnement de sommeil (calme, obscurit\u00e9, etc.).<\/ol>\n<\/li>\n
                                          1. \n
                                              \u00a0\u2022\u00a0Utilisez-vous des aides au sommeil ou des m\u00e9dicaments ?<\/ol>\n<\/li>\n
                                            1. \n
                                                \u00a0\u2022\u00a0Faites-vous des r\u00eaves r\u00e9currents ou des cauchemars ?<\/ol>\n<\/li>\n<\/ul>\n<\/div>\n
                                                \n
                                                  \n
                                                • <\/i> Recours aux th\u00e9rapies conventionnelles et alternatives :<\/strong>\n
                                                    \u00a0\u2022\u00a0D\u00e9crivez bri\u00e8vement vos ant\u00e9c\u00e9dents et votre attitude \u00e0 l’\u00e9gard des diff\u00e9rents types de soins de sant\u00e9, y compris la m\u00e9decine conventionnelle, la chiropractie, l’acupuncture, etc.<\/ol>\n<\/li>\n<\/ul>\n<\/div>\n

                                                    ANT\u00c9C\u00c9DENTS M\u00c9DICAUX DE LA FAMILLE :<\/h3>\n
                                                    \n
                                                    \n
                                                      \n
                                                    • <\/i> Indiquez toute maladie importante survenue dans votre famille imm\u00e9diate :<\/strong>\n
                                                        \u00a0\u2022\u00a0Inclure les parents, les fr\u00e8res et s\u0153urs et les enfants.<\/ol>\n<\/li>\n<\/ul>\n<\/div>\n

                                                        INFORMATIONS COMPL\u00c9MENTAIRES:<\/h3>\n
                                                        \n
                                                        \n
                                                          \n
                                                        • <\/i> Ant\u00e9c\u00e9dents menstruels (le cas \u00e9ch\u00e9ant) :<\/strong>\n
                                                            \u00a0\u2022\u00a0\u00c2ge de la m\u00e9narche, r\u00e9gularit\u00e9, dur\u00e9e, et toute plainte menstruelle.<\/ol>\n<\/li>\n<\/ul>\n<\/div>\n
                                                            \n
                                                              \n
                                                            • <\/i> Bien-\u00eatre mental et \u00e9motionnel :<\/strong>\n
                                                                \u00a0\u2022\u00a0D\u00e9crire tout probl\u00e8me li\u00e9 au stress, \u00e0 l’anxi\u00e9t\u00e9, \u00e0 la d\u00e9pression, etc.<\/ol>\n<\/li>\n<\/ul>\n<\/div>\n

                                                                CONSENTEMENT ET RECONNAISSANCE :<\/h3>\n
                                                                \n
                                                                \n
                                                                  \n
                                                                • <\/i> Par la pr\u00e9sente, je consens \u00e0 ce que le naturopathe utilise les renseignements fournis pour mon traitement.<\/strong><\/li>\n
                                                                • <\/i> Je comprends la nature du traitement naturopathique.<\/strong><\/li>\n<\/ul>\n<\/div>\nSignature<\/strong>:
                                                                  \nDate<\/strong>:<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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