-->

Gender

Age

BMI - Height

BMI - Weight

ISQ - Intro

ISQ - 1

ISQ - 2

ISQ - 3

ISQ - 4

ISQ - 5

ISQ - 6

ISQ - 7

GENERAL - Do you often feel tired and exhausted and/or have fatigue not helped by rest?

GENERAL - Do you regularly experience gas, bloating, and/or tummy trouble?

GENERAL - Do you have regular bowel movements? (No more than 3 times per day and no less than once every 3 days)

GENERAL - Do you exercise at least 30 minutes a day, 5 days per week?

GENERAL - Do you spend at least one hour per day outdoors?

GENERAL - Do you tend to have dry skin and cracked lips?

GENERAL - Do you have trouble sleeping and/or suffer from insomnia?

GENERAL - Do you have close contact with many people on a regular basis outside of household family members?

GENERAL - Are you often exposed to stressful situations?

GENERAL - Do you eat at least 8 servings of fruit and vegetables per day (a serving is ½ cup)?

GENERAL - Do you smoke?

GENERAL - Do you experience headaches and/or nausea when exposed to environmental chemicals, perfumes, and/or prescription drugs?

SECTION 2 - Intro

SECTION 2 - Sore throat:

SECTION 2 - Stuffy nose or sinuses:

SECTION 2 - Swollen lymph nodes:

SECTION 2 - Ear infection:

SECTION 2 - Stomach aches:

Last page 1

Last page 2