Evaluate Your Health

Posted by on May 12, 2015 in News, Nutrition

Part 1:

Please List 3 major health concerns in your order of importance:

1:
2:
3:

Part 2:

Please check the appropriate box on all questions below.

Colon Health

Diarrhea:
NeverSometimesAlways


Constipation:
NeverSometimesAlways

Fuzzy or white coating of the tongue:
NeverSometimesAlways

Passing of foul smelling gas:
NeverSometimesAlways

Use of laxatives frequently:
NeverSometimesAlways

Digestive Function

Excess belching, bloating or burping:
NeverSometimesAlways


Stomach pain within 1-3 hours following a meal:
NeverSometimesAlways

Offensive breath:
NeverSometimesAlways

Sense of fullness during and after meals:
NeverSometimesAlways

Use of antacids:
NeverSometimesAlways

Blood Sugar

Crave sweets during the day:
NeverSometimesAlways


Agitated, frequently upset or nervous:
NeverSometimesAlways

Difficulty losing weight:
NeverSometimesAlways

Increased thirst and appetite:
NeverSometimesAlways

Frequent urination:
NeverSometimesAlways

Mental fogginess:
NeverSometimesAlways

Adrenal Function

Difficulty falling or staying asleep:
NeverSometimesAlways


Crave Salt:
NeverSometimesAlways

Afternoon fatigue:
NeverSometimesAlways

Dizziness upon standing up:
NeverSometimesAlways

Afternoon headaches:
NeverSometimesAlways

Gallbladder Function

Have you had your gallbladder removed:
NeverSometimesAlways


Unexplained itchy skin:
NeverSometimesAlways

Bitter or metallic taste in your mouth, especially in the morning:
NeverSometimesAlways

Do you have bouts of nausea and or vomiting:
NeverSometimesAlways

Colicky pain following high fat meals:
NeverSometimesAlways

Hormone Regulation

Hot flashes:
NeverSometimesAlways


Depression:
NeverSometimesAlways

Disinterest in Sex:
NeverSometimesAlways

Acne:
NeverSometimesAlways

Facial hair growth:
NeverSometimesAlways

Hair loss/thinning:
NeverSometimesAlways

Alternating menstrual cycle length:
NeverSometimesAlways

Part 3:

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