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What are your top 3 health concerns? Priority first.*

Do you have a medical diagnosis? If yes, what is it?

List any Prescription or Over the Counter Meds you take more than 3 times a week.*

List any supplements you take regularly.*

What is your birthdate?*

Are you pregnant or nursing?*

NoYes

What is your current weight?*

How much water do you drink daily?*

Select Oneless than 60 ozmore than 60 oz

How many meals per day contain processed food?*

Select One0123

How many hours do you sleep a night?*

If you wake during the night, what time do you normally wake??

How many bowel movements do you have a day?*

Select OneDon't go daily12 or more

Using the Bristol Stool Chart, (link above) which # represents your stool?*

1

2

3

4

5

6

7

Do you exercise at least 3 times a week?*

Select OneYesNo

Do you have a strained relationship that causes a physical feeling in your body when you think of it??*

NoYes

I would like to receive my evaluation by...

Video review of scan and recommendationsZoom Consultation