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Health: Click to check as many that apply to you now:
Head (HE)
Itchy Scalp Hair Falling Out Dandruff
Head Throat Other Zits, Rosacea, Herpes / cold sores,
CV - Cardio Vascular Cold Hands / Feet High Blood Pressure Low Blood Pressure Total High HDL Low LDL High GI - Gastro Intestinal Upper Gas / Burping Heartburn / Stomach Acid Acid Reflux Ulcers No Appetite craving food (Please list)
EE - Ears / Eyes Itchy Ears Tinnitis, ringing in the ears Loss of hearing Itchy Eyes Watery Eyes Conjuctivitis Red eyeS
NT - Nose / Throat
Runny Nose Snore Sneeze Often Sore Throat Often
Stiff Neck Weight Gain Weight loss Thyroid Hypo / Hyper Stiff Neck
El - Elimination
Gas Constipation Polyps Hemorrhoids
RT - Respiratory / Breathing Wheeze Pneumonia Asthma Bronchitis Breathing Medication(s) Cough Allergies from Air Allergies from Food MS - Muscle / Skeletal Joint pain. Osteoarthritis Arthritis Osteoporosis C2-C7: Cervical ( Neck ) Spine Problems T1-T12: Thoracic Spine Problems L1-L5: Low Back S1-S4: Tail Bone Buldged Disc Herniated Disc Desiccated Disc Spine Pain Curvature
SL - Sleep Sleep problem. feel tired often,
Medication Name (s): Dose amount not needed
Supplements: Herbs, Vitamins, Minerals and other
Main Health Concern(s), Things that bother me the most...
Surgeries: Year/Type
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