Hair Tissue Mineral Analysis - FREE Health Survey (Plus Free Results)

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FREE Health Survey (Plus Free Results)

Good health is not a mundane, one-size-fits-all state of being. Rather, effective health care requires innovation, which often includes not only conventional approaches, but also attention to nutrition and lifestyle.

This free survey is for educational purposes only. Each of the following sections contains questions focused on nutritional conditions that may be affecting your health and personal well being. Any statements below or any on accompanying web pages are for your own research and are not to be misconstrued as medical cure, diagnosis, treatment, disease prevention or health assessment.

Please complete the survey using either a printout or a separate piece of paper on which to write your responses. Answer each question by writing down the number that best describes your situation, then total your score for each section, and submit your answers in the message window at the bottom. Upon receipt, a health care advocate will get back to you in strict confidence with suggestions that target your situation. None of this information has been evaluated by the Food and Drug Administration (FDA).

Section A
For each question in this section, write down the number that best describes your situation:
0 = Never, 1 = Sometimes, 2 = Often

1. How often do you eat fast food?
2. How often do you eat process food? (e.g. frozen dinners, canned foods)
3. How often do you eat cooked foods?
4. How often do you drink carbonated beverages?
5. How often do you drink caffeinated drinks? (e.g. coffee, cola)
6. How often do you drink alcohol?

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Section B
For each question in this section, write down the number that best describes your situation:
0 = Never, 1 = Sometimes, 2 = Often

1. How often do you experience bloating?
2. How often do you feel sleepy after eating?
3. How often do you have uncomfortable reactions after eating?
4. How often do you eat processed and/or cooked foods?
5. How often do you have diarrhea after eating?
6. How often do you feel flush (feel hot) after eating?
7. How often do you have difficulty breathing after eating?
8. How often do you see your food pass through undigested?
9. How often do you get indigestion after eating?
10. How often do you have excess stomach acid?
11. How often do you have heartburn?
12. How often do you have trouble sleeping?
13. How often do you experience weakness or faintness between meals?
14. How often do you have difficulty gaining or losing weight?
15. How often do you have pain in the upper right quadrant of the stomach?

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Section C
For each question in this section, write down the number that best describes your situation:
0 = Never, 1 = Sometimes, 2 = Often

1. How often do you have a low level of energy?
2. How often do you get depressed?
3. How often do you have trouble with your short-term memory?
4. How often do you have low energy after eating?
5. How often do you have low stamina?
6. How often do you experience excessive fatigue during workouts?
7. How often do you experience heartburn after eating?
8. How often do you have sugar cravings?
9. How often do you feel tired after a full night of sleep?
10. How often do you feel too full after eating?
11. How often do you have cravings for fatty foods?
12. How often do you eat unbalanced meals? (e.g. meats vs. vegetables)
13. How often do you feel exhausted after your usual daily activities?

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Section D
For each of the following questions 1 - 10, write down the number that best describes your situation:
0 = Never, 1 = Sometimes, 2 = Often

1. How often do you have hemorrhoids?
2. How often do you get bloody noses?
3. How often do you have bleeding gums?
4. How often do you smoke?
5. How often do you get exposed to second-hand smoke?
6. How often do you get exposed to smog?
7. How often do you experience excessive nervousness?
8. How often do you work around computers, electrical appliances, etc.?
9. How often do you get colds?
10. How often do you have heartburn?
For each of the following questions 11 - 15, write down the number that best describes your situation:
0 = No, 2 = Yes
11. Do you have age spots?
12. Do you have deteriorating eye sight?
13. Do you have excessive wrinkling of skin?
14. Do you have varicose veins?
15. Do you bruise easily?

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Section E
For each of the following questions 1 - 8, write down the number that best describes your situation:
0 = Never, 1 = Sometimes, 2 = Often

1. How often do you have gas, flatulence, bloating belching or burping?
2. How often do you have diarrhea?
3. How often do you get sick?
4. How often do you have cold sores?
5. How often do you experience yeast infections?
6. How often do you consume alcohol or carbonated beverages?
7. How often do you suffer from migraine headaches?
8. How often do you consume dairy products?
For each of the following questions 9 - 13, write down the number that best describes your situation:
0 = No, 2 = Yes
9. Do you have bad breath?
10. Do you have house pets?
11. Do you suffer from hemorrhoids?
12. Have you taken antibiotics over the last 90 days?
13. Have you traveled outside the U.S. within the last 90 days?

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Section F
For each of the folllowing questions 1 - 8, write down the number that best describes your situation:
0 = Never, 1 = Sometimes, 2 = Often

1. How often do you get leg cramps?
2. How often do you have muscle pain?
3. How often do you have deep aching in your bones?
4. How often do you have joint pain in your legs, arms, hands, or feet?
5. How often do you have trouble becoming mobile in the morning?
6. How often do your joints feel inflamed?
7. How often do you have disc problems?
8. How often do you have arthritis?
For each of the following questions 9-10, write down the number that best describes your situation:
0 = No, 2 = Yes
9. Are your joints calcified or misshapen?
10. Do you have a decreased range of motion in your joints?

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Section G
For each of the following questions 1 - 8, write down the number that best describes your situation:
0 = Never, 1 = Sometimes, 2 = Often

1. How often do you get exposed to smog?
2. How often do you experience nervous tension?
3. How often do you have trouble sleeping?
4. How often do you experience sexual malfunction?
5. How often do you feel exhausted?
6. How often do you experience mood swings?
For each of the following questions 7 -12, write down the number that best describes your situation:
0 = No, 2 = Yes
7. Do you experience arrhythmias? (i.e. irregular heartbeat)
8. Do you have high blood sugar
9. Do you have mercury fillings in your teeth?
10. Do you use an anti-perspirant that contains aluminum?
11. Do you have high cholesterol? (i.e. a count over 200)
12. Does your family have a history of heart disease?

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Section H
For each of the following questions 1 - 8, write down the number that best describes your situation:
0 = Never, 1 = Sometimes, 2 = Often

1. How often do you experience sexual dysfunction?
2. How often do you have difficulty with menstrual regulation? (women only)
3. How often do you experience fatigue?
4. How often do you experience “hot flashes”? (women only)
5. How often do you have mood swings?
6. How often do you lose your libido, your sexual drive?
7. How often do you experience short-term memory loss?
8. How often do you experience loss of energy?
For each of the following questions 9 - 13, write down the number that best describes your situation:
0 = No, 2 = Yes
9. Do you have premature graying of your hair?
10. Do you have loss of skin elasticity?
11. Are you experiencing muscle loss and fat increase?
12. Do you have difficulty recovering from minor injuries?

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Section I
For each of the following questions 1 - 3, write down the number that best describes your situation:
0 = Never, 1 = Sometimes, 2 = Often

1. How often do you drink and drive?
2. How often do you experience high stress?
3. How often do you experience frustration and anger?
For each of the following questions 4-8, write down the number that best describes your situation:
0 = No, 2 = Yes
4. Do you tend to drive your car aggressively?
5. Do you work, or have you worked, in a toxic environment?
6. Do you spend eight or more hours a day sitting at a desk or in a car?
7. Do you smoke?
8. Do you live in a major urban or suburban area?

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Congratulations on completing the survey! Please provide your name, email address and section totals below as A = , B =, C =, etc.
Click "Send Email" button to submit, and a health care advocate will reply to you with confidential suggestions that specifically target your situation.