Health Assessment Registration and Payment Form

Due to high demand there is a waiting time of up to 8-weeks for Health Assessments with Andrew. 
The first availability for an assessment is week commencing 7th September 2020.
If you are ready to book your assessment, please do so now to secure the earliest possible date.
Please tick to confirm that you have read the above statement about availability of sessions. *
Please complete this form to register and pay for your Fertility Health Assessment with Andrew Loosely.
If you need any help with the form, please email us at:

Company Details

Company Name: Andrew Loosely Clinics Ltd, trading as Natural Fertility Expert
Company Number: 10210937
Location: Andrew Loosely Clinics Ltd is a company registered in England and Wales, and trades from the UK. 
Registered Office: 2 Lake End Court, Taplow, Berkshire, SL60JQ, United Kingdom
VAT Number: 244314236

Your Details

Free Chat

Have you previously had a free online chat/consultation with Andrew in the last 6 months? * If no - Before you proceed we advise that you first book in for a free 30- minute consultation *

The Assessment

The assessment with Andrew will help you to gain clarity on what’s presenting itself with your fertility health, so that you can confidently take your next steps to choose the best diet, lifestyle and treatment support to help you get closer to your goal of conceiving and birthing your baby.
If you are already pregnant and seeking Pregnancy Support, the Assessment will focus on how to optimise and support your pregnancy based on your unique health needs.
During the Assessment Andrew will:

  • Review Your Medical History and Test Results – to  establish whether there is anything presenting itself that could be stopping you from conceiving or carrying to full term. Andrew will explain your test results to you, so that you know exactly what each one is telling you and what that means for your fertility health.
  • Complete Your Chinese Medicine Health Diagnosis – to find the root cause of why you’re not getting pregnant or carrying to full term according to Chinese medicine fertility principles. This will provide you with clarity about your fertility health, and allow you to understand your root health balance and how this is affecting your fertility. 
  • Create a Plan of Action – to design a clear, focused and structured way forward so that you know what you should be focusing on. You’ll find out which treatments and support will be best for you, when to use them throughout your journey, including IVF (if that’s an option), and how long to use them for to get the best results. 
  • Answer Your Questions - To ensure that you leave the session feeling more focused and relaxed about the next steps on your fertility journey. 


The Assessment fee includes UK VAT (Value Added Tax/Sales Tax) of 20% applicable in all countries.
Payment is in Great British Pounds £ (Sterling).
The fee including VAT is £370

Attending the Assessment

Who will be attending the session? *
Would you like a partner to be assessed too? (Can be carried out even if they do not attend) *
Your session will be carried out using Zoom. These sessions can be recorded and will be emailed to you after the session.

Would you like your session to be recorded? *

Important Terms and Conditions. Please Read

Following is a description of our KEY Terms and Conditions in simplified terms.

Click here to read the detailed Terms and Conditions:
Assessment Details:
i. The Assessment is priced at £370 including UK VAT at 20% (Value Added Tax). This tax is applicable to all countries.
ii. Payment must be made in advance of the session for us to book a date for you. On completing this form you will be taken to a secure payment page and once payment is received we will email you to book your Assessment. We are open Monday to Friday only, so please don't worry if you pay over the weekend and don't hear from us immediately. We will email you as soon as we are back in the office.

iii. The Assessment is an online session that will last between 2-3 hours. Please allow up to 3 hours, so that there is sufficient time for Andrew to cover everything with you.

iv. The Assessment is a stand alone session, and you are not committed to any further sessions or treatment once the assessment is complete.

v. After the Assessment you can decide whether to join The 5 Foundations Program, or just continue without us, and follow the guidance Andrew has given you in this session.


Booking and Cancellation:

i. Sessions are booked on a first come first served basis once payment has been made. 

There is a typical waiting time of 3 - 6 weeks for the Assessment. 

We cannot guarantee your exact requested time and date, but will work with you to find the most suitable and soonest availability.

ii.You have the legal right to cancel your Assessment and receive a full refund minus the credit card charges from the transaction within 14 days of purchase. After 14 days a refund is no longer possible.

iii. Rescheduling of your Assessment can be carried out one time only, up to 7 days in advance of the confirmed session date. 

iv. Less than 7 days notice of cancellation will result in a charge of the full amount of the Assessment fee (£370 including VAT) and the session will not be rescheduled or refunded.

v. This Assessment is non-transferable and not for resale.

vi. Any special offers or bonuses connected to this Assessment are non-transferable, non-refundable, not for resale, and not redeemable for cash.


Preparing for Your Assessment:

i. There are important online questionnaires for you to complete before your Assessment date.  

Once you have submitted this form and made the payment you will receive an email providing important links to the Assessment questionnaires you need to complete.

ii. You agree to complete and submit these forms at least 7 days in advance of your session date. You will be reminded of this again later.

Please note: Questionnaires typically take around 60 - 90 minutes to complete, depending on the quantity of information you provide. 

iii. You agree to inform us if you are unable to complete these forms at least 7 days in advance of your session date.

iv. Submitting your forms less than 7 days before the Assessment date may result in the session being cancelled. The session will not be refunded in this case.


Bank Charges and Taxes:

i. You agree that any bank charges or fees for payment by your bank will be paid in full by you.

ii. Andrew Loosely Clinics Ltd is incorporated and trades in the United Kingdom (UK) and is therefore required to charge Value Added Tax (VAT) on all products and services to all other countries. VAT is included in the pricing of this product as stated above.



To read about how we use the data collected here and in future forms whilst you use our services please click the following link: 'Client Privacy Policy'

By ticking here and signing below you explicitly consent to us processing the personal data you have included in this form in accordance with our Privacy Policy that is set out on the above link 'Privacy Policy'.

You also agree to our Terms and Conditions. *

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Your Signature *
We may from time to time email you details of our goods or services that we feel may interest you, including promotional offers about events, tips, or products to further support your fertility journey. You may opt out of receiving such communications at any time. If you would NOT like to receive such offers, please tick below:

Please click the button below to be taken to our secure payment page. Payment must be completed before the Assessment can be booked and proceed.

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