Health and Hormone Boost Breakthrough Session Application Form

Thank you for applying for a Health and Hormone Boost Breakthrough Session with me!

In this Breakthrough Session I'll help you to:

    Create a sense of clarity about the health and vitality you really want to have 

    Discover the essential building blocks for having the health and vitality of your dreams 

    Determine the #1 thing stopping you from having the health that you want 

    Identify the most powerful actions that will move you toward the health you desire 

    Complete the consultation with the excitement of knowing EXACTLY what to do next to create the health and vitality you truly want 

I am really excited to be able to explore with you some ways in which you can improve your health and wellbeing through hormone balance. It is my passion in life to help busy women and men like you to really get to grips with their health & explore the root cause of any problems.

Please take the time to complete the application form as accurately as possible, to give a clear picture of your unique situation, motivation and readiness to get started.

Be sure to click the "Save and Submit" button just once when you've finished.

My office will be in touch soon!


With Best Wishes,

Dr Alison

Dr Alison Grimston, MBBS MPhil MRCGP DRCOG
44 (0) 7801 710 579



How old are you?

When it comes to your health, what are your biggest challenges?

On a scale of 1 to 10 (10 being the highest) , how important is it to to get these solved and why?

What's the #1 obstacle that's kept you from solving these challenges?

Where would you like your health to be in 6 months?

12 Months?

What therapies, medicines, herbs, supplements and/or diet programs are you currently using, or have you tried in the past, to address your health concerns?

Have you had any other medical conditions, surgeries, or hospitalizations related to this health issue?

How are your energy level, mental focus, and libido?

How did you hear about Dr Alison and her Hormone Success System?

What' s the best way to reach you - phone, Skype or email?

If phone/ Skype is best, when is the best time or day to reach you, and what is your time zone?