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Male
Female
text OK Other_1
work
home_1
best
OK
best_1
OK_1
best_2
OK_2
best_3
OK_3
Asian
African American
Hispanic
European
Middle Eastern_1
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Spouse
Partner
Parents
Children
Friends
Alone
YES
YES_3
YES_1
YES_4
vegetarian
vegan
raw
lacto vegetarian
diabetic
blood type diet
Ayurvedic
gluten free
Paleo
Other_1
NO
YES_2
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joy
happiness
anger
sadness
fear
anxiety
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my hunger level is variable and I can
I have a strong appetite and I don t like
I like to eat but I can go without
If I miss a meal
If I miss a meal_1
If I miss a meal_2
NO
I prefer to eat 3 meals a day at the
I do fine with 3 or even 2 meals a_1
After eating I often experience gas or
After eating I often experience
After eating I often feel heavy
most beans
hot
cabbage
broccoli
salads
oily foods
fried foods
milk_2
bread wheat
cheese
milk_1
wheat
Other_1
onions
garlic
vinegar
yogurt
oily foods_1
Other_2
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tomatoes
I tend to get or can easily be_1
I tend to have 2 or more bowel_1
I generally just have 1 well formed_1
I usually don t gain weigh very easy_1
When I gain weight_1
I gain weight easily and lose it
I was thin before bearing children etc_1
I am generally muscular or athletic_1
I am heavy full bodied or over
I can get cold easily and prefer warm
I can get warm and even hot easily_1
I can adapt to most weather but
My skin tends to be dry
itchy or
My skin tends to red with
burning or
My skin tends to be oily with
with blackheads
with a rash
white pimples
I tend to sleep lightly and awake very
I tend to sleep soundly and awake with
I tend to sleep deep and long
It can be difficult for me to sleep
I often wake up in the night
It can be difficult for me to get up in
Low
medium
high
from work
from family
from health
feel groggy in morning
wake up feeling refreshed Need coffee in the
morning
NO_1
evening Do you
take naps
get sleepy in the day
feel fatigued later in day
feel exhausted at end
get a second wind of energy in the evening Details and any products used for energy
YES
sharp pain
dull pain
pain in front of head
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can t
intense hunger
continual weight
film on tongue
general dryness
excess thirst
bad breath
feelings of heaviness
regular gas
excess body heat
body odor
low appetite
poor sleep
loose stools
needing more sleep
groggy in morning
less than 1 bowel
irritable mood
lack of appetite
feelings of dullness
sinking stools
restlessness
clammy hands
strong smelling stools
bloating colon_1
slow action_1
lack of energy
abdominal gurgling
nausea
oily skin
heavy film on tongue
general abdominal
vomiting
mental lethargy
bitter taste in the mouth
muscle tenderness to
lack of sweat
blackish stools
pain in lower back
general congestion
skin liver spots
constipation
diarrhea
swelling
lethargy laziness
hemorrhoids_1
regular
mucus
mental fog
YES_2
fast racing heart
intense heartburn_1
nasal congestion
heavy mental fog_1
muscle twitching
intense heartbeat
respiratory allergies
low grade fever
skin rashes hives
slow heart beat
stiffness
general aches and pains
dull vague body
cracking joints
hot flashes
sensitivity to chemicals
tension headaches
burning pains
dull headaches
chronic fatigue
hyperactive
YES
food allergies
restless sleep
migraines
lymphatic congestion
dry cough
sharp painful
wet cough
very dry skin_1
chronic edema_2
chronic pain
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YES_1
chronic dry skin
hives pb_1
rashes pb
cold and clammy skin
generally coldness or chills
acne
sinus congestion ak
dizziness
sensitivity skin
swollen lymph glands
dehydration
excess thirst
red or yellow skin
frequent coughing
fever with chills
eczema
hay fever
frequent colds
fast heart rate
high fever
excess mucus
excess saliva
hypersensitive especially loud sounds
recent moles
fungal infections
low fever
dark skin coloration
bruise easy
general swelling
edema
NO
hypoglycemia
hyperglycemia
poor circulation vv MD
red skin pb
YES_1
pale skin color pallor
cold hands and feet vv MM
hives pb
rashes pb_1
chronic edema ks
NO_1
burning hands or feet
varicose veins with clotting
craving meat
canker sores sores in mouth
fungal infection
cracked skin
bleeding gums
NO_2
deep blood clots
heart palpitations
hot flashes
enlarged liver
cold
chemical sensitivity liver
high cholesterol
craving spicy foods
sensitive liver
anemia
psoriasis
glaucoma
hot
diabetes
high blood pressure K MM MD
craving protein or meat
bleeding gums_1
excess ear wax
YES
muscle tenderness
dental tartar
stiff muscles
weak muscles
muscle inflammation
loss of muscle tone
weakness and general fatigue
chronic tissue pain
lumps in breasts
receding gums
exposed bones
fibromyalgia
fibroid
spasms twitches
chronic fatigue syndrome
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wasting of muscles
tumors
muscle pain sharp
craving for fat ie oil cheese
profuse sweating
sugar cravings pre
low urination
intense thirst
slow metabolism
dry and hard feces
sensitive to fatty foods
cold sweat
premature aging
boils pb MM
oily skin
cracking joints ks
frequent urinary infections
excess urination
weight loss o
frequent kidney infections
gallstones
poor sleep
fatty diarrhea
low libido
adrenal exhaustion fatigue
overweight
obesity
pre diabetes
diabetes
lots_1
some_1
little_2
lots_3
some_3
little_4
lots_5
some_5
little
lots
some
little_1
lots_2
some_2
little_3
lots_4
some_4
little_5
soft and bouncy
firm
hard and rubbery Other_1
mineral deficiencies pre
hair loss
joint swelling ks
bone fractures
nail fungal infections
joint calcification
pitted teeth ks
arthritis
bone spurs
tooth cavities ks
bone inflammation
excess hair growth
cracked or brittle nails ks
bone infection
bone tumors
degenerative bones
tooth abscesses
hypothyroidism
osteoarthritis
hyperthyroidism
scoliosis
rheumatoid arthritis
tingling
numbness
interrupted sleep
YES
tremors
spasms
chronic low fever
YES_1
poor memory kt vp
herpes
excessive sleep
racing mind
spacey
burning feet or hands
chronic sluggishness
poor coordination
systemic pain or inflammation
tumor s_1
worry fear anxiety kt
vomiting
hiccups vp
mild melancholy
cataract
anger
cataract_1
ADHD
MS
Parkinson s
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multiple sclerosis
intense depression
Alzheimer s disease
low blood pressure
easy bruising
ankles swelling ks
irregular heart beat
palpitations
chest heart pain
varicose veins vv
fainting
high blood pressure
blood clots
cold hands or feet vv
high cholesterol
burping vp
abdominal pain
vomiting
nausea
bad breath
poor appetite t
bloating va vs
acid reflux pp
GERD
mucous in stools
colitis
IBS
blood in stools pr
rectal pain
gallstones
gas va vs
ulcers
abdominal pain_1
fatty or congested liver
hemorrhoids
indigestion
heartburn
fatty or fried foods
dairy
nuts
gluten products
other_1
dry cough ka
coughing blood
hay fever
NO_1
shortness of breath without exertion
sore throat
cough with mucus ka
difficulty breathing when lying down
pneumonia
allergies
NO
congestion
breathlessness
pain on breathing
bronchitis
asthma
YES
bowel movements are dry and
bowel movements are loose and
bowel movements are well formed
diarrhea vs
Less than 1 bowel movement per
2 or more bowel movements per
usually just 1 bowl movement per
dark brown
light brown
tan or grayish
greenish
blackish
oily
has mucus
sticky
dry
floating
sinking
foul odor
with blood
alternating between constipated
Enemas
hydrotherapy
Laxatives_1
decrease in flow va
painful urination
burning urine
frequent urination
irregular flow va
blood in urine
kidney bladder stones
dry mouth
urgency of urination
inability to hold urine
water retention ks
pain in bladder
urinary track infection
poor kidney function
kidney dysfunction
kidney disease
kidney failure
light yellow
dark yellow
clear
smelly
stains cloths underwear
YES_1
YES_5
YES_2
YES_4
vaginal itching
genital herpes
uterine cysts
fibroids
vaginal dryness
pelvic inflammatory disease
anemia
premature orgasm
vaginal infection
NO
painful intercourse va
burning in vaginal area
vaginal yeast overgrowth
YES_3
Infertility
Hysterectomy
tubal ligation
Mastectomy
Lumpectomy_1
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YES
menstrual cycle is irregular
menstrual cycle is regular
menstrual flow is heavy va
menstrual flow is light va
menstrual flow is medium
craving for sweets
anxiety
nervousness
mood swings
irritability
weight gain
heart palpitations
increased appetite
water retention edema swelling
bloating
night sweats
fatigue
confusion
headaches
breast welling enlargement
insomnia worse sleep
hives rashes acne
feelings of depression
abdominal pain cramping va
migraine headaches
rarely have pain or cramping
lower back pain va
hot flashes
low libido
tender testicles
heavy testicles
cold testicles
blood in semen
excessive desire for sex
nervous premature ejaculation
prostate pain
enlarged prostate
low levels of fertility
burring or pain during ejaculation
emotional premature ejaculation
sterility
overly excited premature
low sexual stamina
sweets
coffee
cola
salt
hot spices
chocolate_1
fats
starches breads
crunchy
3 or more
3 or more_1
3 or more_2
have snacks at night
candy
cookies
bread
chocolate
cheese
crackers or chips
ice
soda
fruit
veggies
protein bars
nuts
fruit smoothie
veggie juice
CheckBox_0
YES_3
NO_3
YES_1
NO_1
YES_4
NO_4
YES
NO
YES_5
NO_5
YES_2
NO_2
YES_6
NO_6
NO
NO_1
NO_2
small
med
large
small_1
med_1
large_1
small_2
med_2
large_2
coffee
with sugar
coffee_1
with sugar_1
coffee_2
with sugar_2
black
green
with
black_1
green_1
with_1
black_2
green_2
with_2
herbal_3
herbal_4
herbal_5
butter
salted
Ghee
butter_1
salted_1
Ghee_1
butter_2
salted_2
Ghee_2
bagel
sweet bread
biscuit
bagel_1
sweet bread_1
biscuit_1
bagel_2
sweet bread_2
biscuit_2
eat in a cafeteria or restaurant
eat in a cafeteria or restaurant_1
eat in a cafeteria or restaurant_2
fast food
fast food_1
fast food_2
wheat
white
rye
wheat_1
white_1
rye_1
wheat_2
white_2
rye_2
gluten free rice
gluten free rice_1
gluten free rice_2
rice
from box
white rice
brown rice
white rice_1
brown rice_1
oatmeal
other_2
other_3
Beans_1
Beans_2
Beans_3
chicken
beef
turkey
fish
beef_1
chicken_1
fish_1
beef_2
chicken_2
bacon sausage
Other_3
lamb
turkey_1
Other_4
lamb_1
turkey_2
Other_5
cheese
cheese_1
cheese_2
whole_1
low fat_1
whole_3
low fat_3
whole_5
low fat_5
Organic
Raw
Organic_1
Raw_1
Organic_2
Raw_2
tomatoes
potatoes
garlic
tomatoes_1
potatoes_1
garlic_1
tomatoes_2
potatoes_2
garlic_2
green veggies
corn
chilli
green veggies_1
corn_1
chilli_1
green veggies_2
corn_2
chilli_2
Juice fruit_3
Juice fruit_4
Juice fruit_5
Juice Veggie_3
Juice Veggie_4
Juice Veggie_5
leftovers
leftovers_1
leftovers_2
Fruit_3
Fruit_4
Fruit_5
margarine
mayo
nut butters
margarine_1
mayo_1
nut butters_1
margarine_2
mayo_2
nut butters_2
whole
low fat
whole_2
low fat_2
whole_4
low fat_4
organic
raw
organic_1
raw_1
organic_2
raw_2
Vegetables
Salads
soups with
Salads_1
soups with_1
one
two
more
Salad dressing with_4
Salad dressing with_5
jam jelly_2
honey
sugar
jam jelly_3
honey_1
sugar_1
jam jelly_4
honey_2
sugar_2
Pasta_2
Pasta_3
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a returning client
a prospective client
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