LIFESTYLE ANALYSIS

Please readNotice!

Remember one of the famous sayings: "Physician, Heal Thyself!" It has been proven conclusively the use of non evasive techniques such as Iridology, Homeopathy and the Chinese methods of assisting the body to heal itself work wonders as opposed to standard Western medical approaches, in most all cases. Each person and their situation are of course unique. Each person needs to check with a qualified health professional when there is any question regarding the presence or treatment of any abnormal health condition. It is a sign of wisdom, not cowardice, to seek more than one opinion. However, each of us has the full capability within to heal ourselves.

Do you believe you are what you eat? Many people do and if you really think about it - it's true. There are many approaches to determining what is going on within your bodily systems. All of these are a part of a larger family of natural and drugless healing arts, plus good nutrition. There is an additional approach to determine the root of problems (rather than just taking care of the symptoms) you may have. This is: Lifestyle Analysis A straightforward analysis of your lifestyle with suggestions of how to better manage keeping yourself fit and in shape. Most of these questions are usually included in a face-to-face interview with a professional. If you are interested in such analyses, presented are several general questions for you to submit and receive answers - if you desire more information. These can be a start, but will not take the place of actually seeing a professional for any problem you may have.

We suggest you consider chosing a professional Naturopathic, Homeopathic or nutrition specialist near your location, or you may view the list through the Alternative Medicine page by clicking here.

The Lifestyle Analysis questionnaire below takes less than 5 minutes to complete and is FREE.
Please answer the following questions; be as brief as possible:

Please complete the following form:


Today's Date:   
Name:                
Address1:            
Address2:           
Town/City:              
State:           Zip Code:       
Province:       
Country:        
Your Phone Number?     
Your E-Mail Address?    (Only for us)
Your Internet Address?

LIFESTYLE ANALYSIS QUESTIONS

1: Do you have any on-going health problems?  
If so, what are they? (Please enter information into the box below, be brief and concise!) 

2: Do your eyes ever ache? 3: Do you ever have hearth burn?  
4: Do you ever have gas? 5: Do you ever have ringing in your ears?  
6: Do you use any tobacco products? 7: Do you have night blindness?  
9: Do your gums ever bleed? 10: Do you have bad breath?  
11: Do you have nasal congestion?  
12: Do you have sinus congestion?  
13: Do meats and milk products give you gas?  
14: Are you ever constipated? 15: Do you use laxatives?  
16: Do you ever have diarrhea? 17: Do you have hemorrhoids?  
18: Do you have joint aches?  
19: Are your hands and feet sometimes colder than the rest of your body?  
20: Do you sweat easily with mild exercise?  
21: Are the glands in your jaw or armpit ever sore to the touch?  
22: Do you have any skin problems?  
23: Do any of your nails grow at different rates than other nails?  
24: Is the color the same under all nails?  
25: Are your teeth overly sensitive?  
26: Do you think your libido is normal?  
27: Would you like it to be better than it is?  
28: Do you use any anti-perspirants?  
29: Do you urinate frequently or in small quantities?  
30: Are you taking any medication whatsoever?  
31: Have you taken any medications in the past?  
32: Did any doctor ever diagnose you with any condition that you still have such as hypertension, arthritis, etc.? Please name the condition(s):  
33: Do you think you could feel better? 34: Do you consider yourself agile?  
35: Do you sleep soundly?  
36: Do you crave sugar or white flour products?  
37: Tell me about your normal consumption of sweets each week?  
38: How much water each day do you drink?  
39: How fast does your hair grow?  
40: How much coffee do you drink each day?  
41: How much soda pop do you drink each day?  
42: How much alcohol each week do you consume?  
43: Do you have headaches?  
44: How often do you have headaches?  
45: If you have headaches, when do you most often have them?  
Please describe your headaches as briefly as possible: 

 

46: What is your weight? (Lbs. or Kg) Select: Lbs or Kg 
47: What is your height (Ft/In or Mtrs/Cm)? Select: Ft/In or CM 
48: How do you feel generally?  
Please enter your own brief comments to question 48 below: 

49: How many hours a night do you sleep?   
50: Do you do any non-work related exercise?  
Please enter a brief answer in the box: (Jog daily, gym workout, bike, etc.) 

51: Please describe the following as briefly as possible: 1) Typical breakfast, 2) Typical lunch, 3) Typical supper, and 4) Typical snacks:  

 

THANK YOU FOR TAKING TIME 
TO COMPLETE THIS QUESTIONNAIRE!

Submit Your Own Questions!

If you desire to submit your own specific questions, please use the following form to enter your question(s).
Answers to questions will be returned via e-mail or post.(Please be brief and concise!): 

  

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Go also to Health Analysis (Intake) Form

This form may be copied for your own web site as long as you notify
Karinya that you are doing this and that you give www.karinya.com as the source.

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