Please list your main health concerns
At what point in your life did you feel best?
Allergies or sensitivities? Please explain.
Any serious illnesses/hospitalizations/injuries?
How is/was the health of your mother?
How is/was the health of your father?
What is your ancestry?
What blood type are you?
Reached or approaching menopause? Please explain.
How is your sleep?
Birth control history
How many hours?
Do you experience yeast infections or urinary tract infections? Please explain.
Do you wake up at night? Why?
Do you take any supplements or medications? Please list.
Any healers, helpers or therapies with which you are involved? Please list.
What role do sports and exercise play in your life?
Snacks and Liquids
Will family and/or friends be supportive of your desire to make food and/or lifestyle changes?
Do you cook?
What percentage of your food is home-cooked?
Where do you get the rest from?
Do you crave sugar, coffee, cigarettes, or have any major addictions?
The most important thing I should do to improve my health is –
Anything else you would like to share?