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WANT TO TAKE THE BODY SYSTEMS ASSESSMENT? (YES, I'M READY OR I PREFER PRINTABLE FORMAT)**

Yes, I'm ready!I prefer a printable format to fill out

Poor concentration or memory

Never

Occasionally

Often

Almost Always

Cold hands & feet

Never

Occasionally

Often

Almost Always

Frequent consumption of fried foods

Never

Occasionally

Often

Almost Always

Smoker/Stressful or sedentary lifestyle

Never

Occasionally

Often

Almost Always

Food allergies/difficulty digesting certain foods

Never

Occasionally

Often

Almost Always

Heavy coating on tongue

Never

Occasionally

Often

Almost Always

Belching, gas or discomfort after meals

Never

Occasionally

Often

Almost Always

Fewer than 2 bowel movements per day

Never

Occasionally

Often

Almost Always

Stressful lifestyle or feeling drained

Never

Occasionally

Often

Almost Always

Express emotions in unhealthy ways

Never

Occasionally

Often

Almost Always

Feeling irritable, anxious, moody or down

Never

Occasionally

Often

Almost Always

Feeling that life has little or no purpose

Never

Occasionally

Often

Almost Always

Crave or consume sweets salty or junk foods

Never

Occasionally

Often

Almost Always

Monthly female issues or low sex drive

Never

Occasionally

Often

Almost Always

Feeling irritable, anxious, moody or down

Never

Occasionally

Often

Almost Always

Restless sleep or lack of sleep

Never

Occasionally

Often

Almost Always

Puffiness under eyes

Never

Occasionally

Often

Almost Always

Frequent or painful urination/urinary issues

Never

Occasionally

Often

Almost Always

Diet high in meats and grains

Never

Occasionally

Often

Almost Always

Sore, painful or weak joints/bones

Never

Occasionally

Often

Almost Always

Frequent illness (more than twice per year)

Never

Occasionally

Often

Almost Always

Frequent use of antibiotics

Never

Occasionally

Often

Almost Always

Less than 3 servings of fruits & veggies per day

Never

Occasionally

Often

Almost Always

Stressful lifestyle

Never

Occasionally

Often

Almost Always

Dry, brittle nails

Never

Occasionally

Often

Almost Always

Complexion or other skin issues

Never

Occasionally

Often

Almost Always

Rashes, lesions or bruise easily

Never

Occasionally

Often

Almost Always

Dry, brittle or thinning hair

Never

Occasionally

Often

Almost Always

Lack of energy or chronic fatigue

Never

Occasionally

Often

Almost Always

Exercise less than 2 times per week

Never

Occasionally

Often

Almost Always

Swelling or inflammation

Never

Occasionally

Often

Almost Always

Unexplained chronic issues (headache, skin, etc)

Never

Occasionally

Often

Almost Always

Sore, painful or weak joints/bones

Never

Occasionally

Often

Almost Always

Brittle nails or hair

Never

Occasionally

Often

Almost Always

Muscle cramps or spasms

Never

Occasionally

Often

Almost Always

Diet high in meats, grains or caffeine

Never

Occasionally

Often

Almost Always

Smoker/regularly consume alcohol or caffeine

Never

Occasionally

Often

Almost Always

Tremors, muscle cramps or spasms

Never

Occasionally

Often

Almost Always

Stressful lifestyle

Never

Occasionally

Often

Almost Always

Numbness or tingling

Never

Occasionally

Often

Almost Always

Low sex drive

Never

Occasionally

Often

Almost Always

(Women) PMS or menstrual irregularities

Never

Occasionally

Often

Almost Always

(Men) Impotence or prostate issues

Never

Occasionally

Often

Almost Always

Hot flashes, sweats, irregular body temperature

Never

Occasionally

Often

Almost Always

Exposure to air pollutants

Never

Occasionally

Often

Almost Always

Heavy mucus production or congestion

Never

Occasionally

Often

Almost Always