Personal Information:
Are you retired?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
Health and Lifestyle:
Do you have any allergies or sensitivities?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
If yes, please scale the severity from 1-10 (1 being minor, 10 being severe):
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- No elements found. Consider changing the search query.
- List is empty.
Are you currently on thyroid medication?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
Do you experience joint pain?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
If yes, please scale the severity from 1-10 (1 being minor, 10 being severe)
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- No elements found. Consider changing the search query.
- List is empty.
How is your energy level? Please scale from 1-10 (1 being very low, 10 being very high)
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- No elements found. Consider changing the search query.
- List is empty.
How well do you sleep? Please scale your sleep quality from 1-10 (1 being poor, 10 being excellent)
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- No elements found. Consider changing the search query.
- List is empty.
How would you rate your digestion? Please scale from 1-10 (1 being poor, 10 being excellent)
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- No elements found. Consider changing the search query.
- List is empty.
How is your memory? Please scale from 1-10 (1 being poor, 10 being excellent)
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- No elements found. Consider changing the search query.
- List is empty.
Have you ever lived near a large industrial business?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
Have you ever had a severe mold problem where you lived or worked?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
Have you ever been near a fluorescent bulb when it shattered?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
Do you have strong reactions to poison ivy or oak?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
Do you often feel frustrated or angry?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
Do you have neuropathy (nerve pain)?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
If yes, please scale the severity from 1-10 (1 being minor, 10 being severe)
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- No elements found. Consider changing the search query.
- List is empty.
How healthy is your diet? Please scale from 1-10 (1 being unhealthy, 10 being very healthy)
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- No elements found. Consider changing the search query.
- List is empty.
Do you smoke?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
Do you drink alcohol?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
Do you live in a city?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
Have you ever lived in a place where a business was investigated for polluting water or air?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.
Do you live on or near a farm?
- Yes
- No
- No elements found. Consider changing the search query.
- List is empty.