Check the box preceding a question if that particular condition applies to you, if it does not, move to the next question.

Lack of energy
Sore or painful joints
Illness more than twice a year
Difficulty in maintaining ideal weight
Body odor and/or bad breath
Low endurance/stamina
Difficulty in digesting certain foods
Lack of balanced diet
 
Eat meat more than 3 times/week
Slow recovery from illness
 
Monthly female concerns
Less than 2 bowel movements per day
 
Recent or frequent use of antibiotics
Lack of appetite
 
Regular consumption of Alcohol
Low sex drive
 
Frequent mood swings
Brittle or easily broken fingernails
Food allergies
Dry, damaged or dull hair
Bags under eyes
High fat diet
Smoking
Unsettled, apprehensive, pressured
Poor concentration and/or poor memory
Low fiber diet (Not enough fruits)
Poor resistance to disease
Muscle cramps or spasms
Belching or gas after meals
Exposure to air pollution daily
 
Stressful lifestyle
Cokes, sodas, caffeine consumption daily
Skin/complexion problems
Feeling out of control
Cravings for sweets and/or processed foods
Food/Chemical sensitivities
Regular consumption of dairy products
  (milk, cheese, cream, butter, ice cream)
Recurrent yeast/fungal infections
 
Feeling low, uninterested, angry
Weak bones, teeth or cartilage
 
Too little sleep or restless sleep
Suffer from anxiety or worry
Menopausal concerns
Easily irritated or angered
Frequent urination or urinary concerns
Do not exercise regularly
Hair Loss
Respiratory, sinus or allergy problems

   OR