Name
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First Name
Last Name
Email
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Age
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What kind of climate do you live in?
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The weather I am happiest in
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My physical body make up is
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As a child I was
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My lifelong tendency with weight has bee
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Most of my life, my body temperature has felt:
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My joints are
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My nails are
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My hands and feet tend to be
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When I Speak
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My mental activity tends to be
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My thoughts tend to be
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When I am stressed
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My memory tends to be
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In projects I am a
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When it comes to routine I
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Overall, my temperament is
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Most of my life, I have made choices
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I believe money is meant to be
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In general, my stamina over the day is
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My lifelong tendency with sleep has been
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My favorite kind of exercise is
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When I exercise, I
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In general, my appetite is
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When I eat, I like
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My digestion currently is
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Indicate which has been the most common in the last 6 months.
My bowel movements are
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Indicate which has been the most common in the last 6 months.
When I wake up, I
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Indicate which has been the most common in the last 6 months.
In general, I have
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My sleep is
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When I dream, they are
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If I am ill I tend to have
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Please indicate any of the following you may be experiencing; constipation, diarrhea, sinking stools and/or mucus in stool, sticky stools, indigestion, fatigue after eating, bloating; gas, heartburn, bad breath.
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Please indicate any of the following you may be experiencing; fatigue, low energy, weakness, unclear thinking, grogginess.
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Please indicate any of the following you may be experiencing; aches and pains, poor circulation, joint pain and inflammation.
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Please indicate any of the following you may be experiencing; skin inflammation, psoriasis, dandruff, boils, acne.
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Please indicate any health concerns:
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Please indicate any family health history:
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Please indicate any allergies:
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Please indicate your main health goals:
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Is there anything else you would like to share with us?
