Health Assesment Form
My goal is to promote health and TOTAL body wellness in anyone I meet! By filling out the assessment below, I can better see what products may help you. You are, by no means, obligated or being pushed into ordering anything, but you may be able to understand YOU and where you might be able to benefit. this is completely confidential. I will send you back what body system you may be lacking vital nutrients/vitamins/herbs that will completely change how you feel. Regardless if you purchase anything at all, I will give you tips on how to be a better YOU!
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Illness More Than Twice A Year
Difficulty Digesting Certain Foods
Monthly Female Concerns
Regular Consumption of Alcohol
Food Allergies
Smoking
Heavy Coating on Tongue
Stressful Lifestyle
Cravings For Sweets Or Junk Food
Feeling Down, Uninterested Or Moody
Body Odor And/Or Bad Breath
Less Than 3 Servings Of Fruit And Veggies Daily
Recent Or Frequent Use Of Antibiotics
Gum Problems Or Redness On Nose
Puffiness Under Eyes
Poor Concentration or Memory
Belching Or Gas After Meals
Skin/Complexion Problems
Daily Consumption Of Dairy Products
Difficulty Getting To Sleep, Lack of Sleep
Menopausal Concerns
Age-Related Health Problems
Difficulty Maintaining Ideal Weight
Diet High in Meat and Grains
Fewer Than 2 Bowel Movements Per Day
Low Sex Drive
Dry, Damaged Or Dull Hair
Frequently Feeling Fearful Or Timid
Muscle Cramps Or Spasms
Caffeinated Beverages Daily
Restless Sleep Or Waking Up Frequently
Weak Bones, Teeth Or Cartilage
Feeling Irritable Or Easily Angered
Respiratory Concerns
Frequent Urination Or Urinary Concerns
Sore Or Painful Joints
Lack Of Energy Or Endurance
Heavy Mucus Production or Feeling Congested
Weak Knees, Ankles Or Back
Brittle Or Easily Broken Fingernails
Daily Consumption Of Fried Foods
Cold Hands And Feet
Exposure To Air Pollution Daily
Shallow Or Difficult Breathing
Recurrant Yeast Or Fungal Infections
Feeling Anxious Or Worried
Don't Exercise Regularly
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