Health Evaluation

by | Jun 6, 2018 |

Welcome to your Health Evaluation. Please answer the following questions accurately. The results will determine which product suits your needs best.

For questions labelled 0-10, please answer according to the severity of the health problem (0=unnoticeable, 5=mild and 10=severe).

Please enter your name *
Please enter your email *
What are your health-related goals?
How badly do you suffer from high blood pressure:
How severely do you experience back pain, neck pain, or arthritis?
How often do you experience stiff shoulders and headaches?
How often do you experience numbness, or feet/arms falling asleep?
How much trouble do you have falling asleep?
How badly do you suffer from bleeding gums of cavities?
How severely do you suffer from kidney stones or bone spurs:
How badly do you suffer from knee, shoulder or joint pain?
Do you take painkiller medication?
Do you take blood pressure medication?
Do you suffer from Cardiovascular Disease, Eczema, or PMS?
Are you forgetful?
How often do you have trouble breathing?
Do you have eye or eyesight problems?
Do you have age spots or blemishes?
Do you have gray hair, wrinkles or hemorrhoids?
Do you take cholesterol medication
Do you take blood thinners or diuretics?
Do you take fibromyalgia or MS medication?
Do you take Alzheimer or Parkinson medication?
How severely do you suffer from ADD/ADHD, Depression, or Diabetes?
How often do you get sleepy after meals?
How often do you have cravings for sugar or sweets?
How often do you sweat excessively or have excessive thirst
How often do you wake up during the night?
How much trouble do you have with losing weight?
Do you have trouble controlling your blood sugar levels?
Do you take blood sugar medication?
Do you take mood swing medication?
Do you take ADD, ADHD, or autism medication?
How badly do you suffer from food sensitivities, heartburn, or indigestion?
How badly do you suffer from stomach or intestinal pain?
How often do you experience Bloating or Gas?
How badly do experience allergies?
How frequently do you have Constipation or Diarrhea?
Do you have immune system problems/get sick often?
Do you take anti-acids or stomach meds?
Do you take fibre or medication for constipation?
Do you take medication for Crohn's Disease?
Do you take immune system medication?