Your nutritional health's hidden symptoms -- Sample Questions

Sample Nutritional Questionnaire

Taking a few minutes to answer these sample questions (which are the first few questions of the full weighted answer questionnaire) will give me some useful information about your nutritional uniqueness. Should you decide to proceed with the purchase of the full questionnaire and analysis, your complete set of 392 answers will allow me to identify many of the nutritional imbalances or combinations of imbalances that can uniquely affect your body and your health.

Answer as many of the following questions as possible. At the end of the questions, click on "Submit" and your sample answers will be e-mailed to me.

If you wish to purchase the full analysis, click on the "buy now" button and make payment. I will e-mail you a link to the full questionnaire and as soon as I receive your answers I will develop your personal nutritional chart -- showing the likelihood of your deficiencies in 54 different categories including thyroid, mercury, vitamins, minerals, enzymes, etc. Within 24 hours I will upload your personal web page, containing your chart plus links to my comprehensive corrective recommendations for each deficiency detected and send you an e-mail with your page's address. You will be able to use your browser to view, print out and/or save your page(s) to your computer. As a bonus, you will also have the opportunity to e-mail me with any additional questions you might have. You can view a sample client page here.

-- Freda Newman, Nutritional Consultant

Identification information:

Name:

E-mail address:

Have you completed this test before? Yes No

Are you especially interested in weight loss? Yes No

General Background Information:

Age:

Sex:

Height:

Weight:

Describe the environment where you spend most of
your time (air quality, light quality, etc.).

Describe any special diet you are currently following.

Do you frequently take aspirin, antacids or
any other non-prescription medicines?

Yes No

Do you often eat in fast food restaurants?

Yes No

Do you smoke? Yes No

List any information you think should be taken into consideration
when evaluating your state of nutritional health.

Put a 1, 2 or 3 (only) in the box by each question that applies to you.
If your symptom is mild, put a 1. If it is medium, put a 2
and if you have a stong symptom put a 3.

1. Is your hair dry? (answer only as per instructions above)
2. Is your hair brittle?
3. Is your hair dull or lifeless?
4. Is your hair oily?
5. Is your hair falling out?
6. Is your hair thin?
7. Is your hair prematurely grey?
8. Do you have cowlicks?
9. Do you have dandruff?
10. Does your hair grow slowly?
11. Do you have acne?
12. Do you get pimples or blackheads, especially on your upper back or shoulders?
13. Do you get hives?
14. Do you get shingles?
15. Do you have rough, bumpy skin on the backs of your arms?
16. Do you have liver (brown) spots on your skin?
17. Do you have little pink spots or broken capillaries on your skin?
18. Do you get warts?
19. Do you have eczema or psoriasis?
20. Do you get dermatitis or other skin rashes?
21. Do you perspire excessively?
22. Do you feel cold and sweaty or get gooseflesh?
23. Do you feel warm and flushed at normal temperatures?
24. Is your skin warm, moist and fine textured?
25. Is your skin greasy and scaly around your mouth, nose or eyes?
26. Is your skin oily on your nose and forehead?
27. Do you have dry or cracked skin behind your ears?
28. Is your skin generally dry?
29. Is your skin rough, flaky or scaly?
30. Is your skin itchy?
31. Is your complexion sallow (pale grey/green/yellow tint)?
32. Do the soles of your feet and/or palm of your hands have a yellowish tint?
33. Do you have white patches on your skin (vitiligo)?
34. Is your complexion pale?
35. Do you have pale skin, especially on the palms of your hands?
36. Do you have red or inflamed skin?
37. Do you bruise easily?
38. Is your skin aging rapidly?
39. Do you have enlarged facial pores?
40. Is your skin unusually sensitive to the sun?
41. Do you have puffiness or bloating in your face, or under your eyes?
42. Do you have facial and back pain together?
43. Do you see spots?
44. Are you nearsighted (myopic)?
45. Are your eyes sensitive to bright light (sunlight, glare, headlights, etc.)?
46. Is your eyesight getting worse?
47. Do you have poor night vision or find it difficult to adjust your eyes to the light
when entering a dark room?
48. Have you had cataracts?
49. Do the whites of your eyes have red lines in them?
50. Do the whites of your eyes have red blotches in them?

End of Sample Questionnaire -- the Full Questionnaire contains 392 questions on all aspects of your body. If you wish to complete the Full Questionnaire click on the "Buy Now" button and I will e-mail a link to you.

Please note that I am a Nutritional Consultant. I am not a doctor. I do not diagnose or treat disease. Indicate that you understand the importantance of consulting your doctor if you suspect that you have a medical problem.

Yes I understand No I do not understand