1. Is your waistline above 35 inches for women and above 40 inches for men?
Yes
Sometimes
No

3. Do you suffer from unexplainable achy joints or sore muscles?
Yes
Sometimes
No

5. Do you have depleted energy levels, or problems sleeping?
Yes
Sometimes
No

7. Do you have red/puffy/bleeding gums when you brush or floss, or have bad breath?
Yes
Sometimes
No

9. Do you have significant and persistent stress in your life?
Yes
Sometimes
No

11. Do you have diabetes, hypertension, or high cholesterol/lipid profile?
Yes
Sometimes
No

13. Do you take any medications (prescription or OTC - not including nutritional supplements)?
Yes
Sometimes
No

2. Do you, despite considerable effort have difficulty losing weight?
Yes
Sometimes
No

4. Do you suffer from food sensitivities or GI disturbance such as discomfort, bloating, constipation or diarrhea?
Yes
Sometimes
No

6. Do you have dry, patchy, red or irritated skin, itchy ears or irritated eyes?
Yes
Sometimes
No

8. Do you smoke?
Yes
Sometimes
No

10. Do you have persistent unexplained nasal congestion?
Yes
Sometimes
No

12. Do you suffer from any other chronic disease?
Yes
Sometimes
No