| 1. How often do you feel nauseous or experience vomiting? | |
| 2. How often do you feel bloated? | |
| 3. How often do you eat fast/fried foods on a regular basis? | |
| 4. How often do you use laxatives? | |
| 5. How often do you belch or pass gas? | |
| 6. Do you have a history of Hepatitis? | |
| 7. How often do you experience heartburn? | |
| 8. How often do you experience abdominal pain? | |
| 9. How often do you use anti-acids? | |
| 10. Do you have a history of Gastric Ulcers? | |
| 11. Do you have a history of Tonsillitis or Strep Throat? | |
| 12. How often do you experience a kidney or bladder infection? | |
| 13. How often do you use antibiotics? | |
| 14. How often do you retain fluids? | |
| 15. How often do you have bad breath or body odor? | |
| 16. How often do you use margarine on a regular basis? | |
| 17. How often do you feel fatigued or are you sleepy arter eating? | |
| 18. How often do you have cold hands or feet? | |
| 19. How often do you have finger or toe nail infections? | |
| 20. Do you have a history of Mononucleosis? | |
| 21. How often do you experience mood swings with sugar or sweets? | |
| 22. How often do you have dry skin or hair? | |
| 23. What is your stress level (0 meaning 'None' and 3 meaing 'High')? | |
| 24. How often do you experience chronic fatigue? | |
| 25. How often do you experience a low sex drive? | |
| 26. Do you use anit-depressants? | |
| 27. How often do you experience slow reflexes? | |
| 28. How often do you feel sensitive to fumes or chemicals? | |
| 29. How often do you experience a loss of taste or smell? | |
| 30. How often do you experience insomnia? | |
| 31. How often do you have poor exercise tolerance? | |
| 32. How often do you have a loss of mental awareness? | |
| 33. How often do you experience gout? | |
| 34. How often do you experience dizziness when standing up? | |
| 35. How often do you experience headaches? | |
| 36. How often do you have itchy eyes or an itchy nose? | |
| 37. How often do you have chronic sores or fever blisters? | |
| 38. How often do you experience a runny nose or nose bleeds? | |
| 39. How often do you experience anxiety or depression? | |
| 40. How often do you have throat or ear infections? | |
| 41. How often do you have hay fever or seasonal allergies? | |
| 42. Are you taking or have you ever taken thyroid medicine? | |
| 43. How often do you experience hyperactivity? | |
| 44. How often do you have swollen eyes? | |
| 45. How often do you have strong smelling urine? | |
| 46. How often do you experience body aches or find it painful to touch objects? | |
| 47. How often do you have swollen joints? | |
| 48. How often do you have allergies or food sensitivity? | |
| 49. How often to you experience binge eating or drinking? | |
| 50. How often are you sneezing? | |
| 51. How often do you experience skin rashes? | |
| 52. How often do you experience poor decision making? | |
| 53. How often do you have watering eyes? | |
| 54. How often do you breath through your mouth? | |
| 55. How often do you have problems breathing at night? | |
| 56. Do you experience chest pain when you exercise? | |
| 57. How often do you experience heaviness or cramps in your legs? | |
| 58. Do you perform aerobic exercises on a regular basis? | |
| 59. Do you drink five or more cups of coffee a day? | |
| 60. Do you have a history of heart trouble? | |
| 61. Do you have a history of high blood pressure? | |
| 62. How often do you crave sweets or alcohol? | |
| 63. How often do you feel poorly when you miss a meal? | |
| 64. How often do you experience an increased thirst? | |
| 65. How often do you experience night sweats? | |
| 66. Do you have a history of Bronchitis? | |
| 67. Do you smoke or use tobacco? | |
| 68. How often do you experiencie a shortness of breath or a chronic cough? | |
| 69. How often do you cough up phlegm or blood? | |
| 70. How often do you experience frequent urination? | |
| 71. How often do you urinate when you cough or sneeze? | |
| 72. Do you have silver filings in dental cavities? | |
| 73. Do you drink three or more carbonated beverages a day? | |
| 74. Do you have bone or joint disformity? | |
| 75. Have you experienced a recent trauma? | |
| 76. How often do you experience a loss of strength or muscle tone? | |
| 77. How often do you experiencing night cramps? | |
| 78. How often do you experience constipation? | |
| 79. How often do you experience light or dark colored stool? | |
| 80. How often do you experience blood in your stool? | |
| 81. How often do you have recurrent diarrhea? | |
| 82. How often does your heart miss a beat or generate extra beats? | |
| 83. How often to you expereince pain or stiffness when you wake up? | |
| 84. How often do you experience gum disease? | |
| 85. How often do you experience difficulty falling asleep? | |
| 86. How often do you find yourself needing 10 or more hours of sleep? | |
| |
| MALES ONLY |
| 87. How often do you experience low back pain? | |
| 88. How often do you experience erectile dysfunction? | |
| 89. How often are you experiencing known prostate problems? | |
|
| FEMALES ONLY |
| 87. How often do you experience pre-menstrual depression? | |
| 88. How often do you miss menstrual periods? | |
| 89. How often do you experience vaginal itching or discharge? | |
| 90. Do you use hormones? | |
| 91. Do you have vaginal yeast infections? | |
