How Healthy is your Digestive System?
Please answer "Yes" or "No" to the following questions.
Name:
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Email
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Goals:
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Have you taken repeated or prolonged courses of antibacterial or medical drugs?
Yes
No
Have you been bothered by recurrent vaginal, prostate or urinary tract infections?
Yes
No
Do you feel "sick all over," yet the cause hasn't been found?
Yes
No
Are you bothered by hormone disturbances, including sexual dysfunction, low sex drive, sugar craving, low body temperature or fatigue, PMS, menstrual irregularities?
Yes
No
Are you unusually sensitive to tobacco smoke, perfumes, colognes and other chemical odors?
Yes
No
Are you bothered by memory or concentration problems? Do you sometimes feel "spaced out"?
Yes
No
Have you taken prolonged courses of prednisone or other steroids; or have you taken "the pill" for more than 3 years?
Yes
No
Do some foods disagree with you or trigger your symptoms?
Yes
No
Do you suffer with constipation, diarrhea, or do you feel bloated or suffer from abdominal pain?
Yes
No
Is your skin dry? Does your skin itch, tingle or burn; or are you bothered by rashes?
Yes
No
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