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Health Assessment Questionnaire

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Do you have any of the following symptoms?

Lack of energy
High blood pressure
Bad breath
Difficulty digesting certain foods
Changes in your menstrual cycle
Frequent use of antibiotics or medications
Frequent use of alcohol
Mood swings
Allergic to certain foods
Smoke
Lack of concentration and slow memory
Gas bloating after meals
Stressful lifestyle and headaches
Skin problems
Cravings for sweets and processed foods
Feel bored or depressed
Lack of sleep or restless sleep
Menopausal changes in your body
Urinary tract changes, frequent urinating
Hair loss
Low physical activity
Difficulty breathing
Painful joints or bones
Difficulty maintaining ideal weight
Frequent coughing
Get sick easily or frequently
Have intestinal inflammation, constipation
Chest pressure
Back Pain
Lack of appetite
Low sex drive
Fragile or easily broken nails
Dry, dull or damaged hair
High fat diet
Muscle cramps, in the hands or feet
Excessive caffine intake
Fungus problems
Easily irritated or easily get nervous
Inflammation and pain in your feet




Thank you!

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