Health Questionnaire

Do you sometimes eat fast food?

Do you follow a vegan diet (vegetarian, without eggs, without milk)?

Do you drink more than three glasses of wine a week?

Do you have belching, wind or a heavy feeling in your stomach after eating?

Do you have a poor appetite?

Do you have bad breath or a bad taste in your mouth?

Have you partly or completely lost your sense of taste?

Do you tolerate certain foods poorly?

Do you have difficulty swallowing?

Do you have, or have you had, anaemia?

Do you notice undigested food in your stool, or an oily film on the water?

Are you unable to gain weight?

Do you suffer from heartburn?

Do you take acid blockers?

Do you take digestive enzymes?

Are your fingernails soft, brittle or flecked with white?

Are you prone to muscle cramps?

Do you see poorly at night?

Is your skin dry, easily injured, or slow to heal after injuries?

Do you suffer from chronic stress?

Do you feel unwell after skipping a meal, or after eating sweets?

Do you feel dizzy when you stand up quickly?

Do you have trouble sleeping, or do you not feel rested in the morning?

Do you feel more tired or depressed in winter?

Have you lost body hair (men and women) or hair on your head (women)?

Are you sensitive to slight changes in the weather?

Does your skin turn brown, even without sun exposure?

Do you crave salt?

Are you emotionally unstable, or do you suffer from mood swings?

Do you have, or have you had, high blood pressure?

Do you have, or have you had, raised cholesterol or blood lipid levels?

Is there, or was there, osteoporosis in your family or among your ancestors?

Has your libido decreased?

Do you suffer from exhaustion, constipation, weight gain, dry skin or feeling cold?

Do you put on weight mainly around your stomach?

Have you noticed increased thirst or more frequent urination?

Do you feel worse before your period? (women only)

Have you had fertility problems or miscarriages? (women only)

Has your cycle changed? (women only)

Have you felt worse since the menopause? (women only)

Since around the age of 50, have you been more tired or lacking in motivation? (men only)

Have you been in contact with chemicals or toxic heavy metals at work or at home?

Do you have amalgam fillings or root-dead teeth?

Do you eat large fish such as tuna, swordfish, halibut, etc.?

Are you sensitive to the smell of smoke, car exhaust, perfume or cleaning products?

Are you currently taking more than one chemical medicine?

Are you prone to side effects when taking medicines?

Have you noticed problems with concentration or memory?

Have you become sensitive to alcoholic drinks?

Have you had liver disease, hepatitis or glandular fever (Epstein-Barr virus)?

Do you suffer from muscle stiffness, muscle weakness or tiring quickly?

Do you often have headaches?

Do you have mouth ulcers, tooth decay or inflamed gums?

Do you suffer from constipation, diarrhoea or irregular bowel movements?

Is your stool dry, hard, pencil-thin or in small pellets?

Do you also pass mucus or blood?

Do you suffer from flatulence or belching?

Do you suffer from vague abdominal discomfort or cramps?

Have you had two or more courses of antibiotics in the past year?

Have you ever been to the tropics or to less developed countries?

Do you drink water from a well or a stream?

Do you catch colds or flu easily?

Are you slow to recover from an infection?

Do you have swollen glands in your neck, armpits or groin?

Do you suffer from seasonal allergies?

Do you have a permanently blocked nose or postnasal drip?

Do you feel worse (within hours to two days) after eating certain foods?

Do you have dark circles under your eyes?

Do you have, or have you had, asthma?

Have you ever been diagnosed with an autoimmune disease?

Do you suffer from joint pain?

Do you suffer from itching of the eyes, nose, throat, neck or skin?

Are you sensitive to mould, dust, pets or other environmental influences?

Has cancer been diagnosed frequently among your blood relatives?

Do you eat cereal products (such as bread, pasta, cornflakes) and/or dairy products (almost) every day?

Do you have strong cravings for sugar?

Have you ever had to take long or repeated courses of antibiotics?

Do you suffer from lack of energy or poor concentration?