Symptom Survey

Checking two or more of the following symptoms indicates a nutritional imbalance somewhere in the body. Please consider having a comprehensive examination.

Female
❑ Painful and/or irregular menstrual cycle
❑ Missing a menstrual cycle for more than a month
❑ PMS and/or cramps during menstrual cycle
❑ Hot flashes over the age of 45
❑ Frequent urination
❑ Getting up at night to use the bathroom
❑ Depression
❑ High or low blood pressure
❑ Bladder infections
❑ Infertility

Male
❑ Prostate
❑ Frequent urination
❑ Tiredness
❑ Loss of libido (sex drive)
❑ Back pain

Children
❑ Bed wetting
❑ Frequent colds
❑ Colds that last for weeks
❑ Constant coughing
❑ Rashes
❑ Dark circles under the eyes
❑ Ear infections
❑ Colicky, crying often
❑ Lice

General
❑ Headaches
❑ Tiredness
❑ Depression
❑ Sleepless nights
❑ Loss of appetite
❑ Weight gain or loss
❑ Heartburn
❑ Constipation
❑ Moody/Irritable
❑ Short tempered
❑ Easily aggravated
❑ I have been to several other doctors, nutritionists, etc. for my condition and am still suffering.
❑ I have been through countless medical tests and still have no answers to my illness.

Symptoms like these might indicate that your body’s chemistry is out of balance. It can be caused by an organ that has stopped working right or an animal allergy, seasonal allergy, a food allergy, an infection, a chemical poisoning from insecticides, pesticides, soaps, food preservatives, deodorants, shampoos, and metal poisoning from copper, aluminum (cooking in aluminum pots and pans), lead, and mercury. Once these causes are identified and removed from the body proper healing can begin.