Health Check!

Complete the FREE health check form below to help you identify what specific areas of your health can be improved through nutritional supplementation.

Feel free to submit the form so we know your needs and can serve you better.

Please Note: The following information is a guide only. This health check should not be used instead of consultation with a doctor.

Resource: Dunne, Lavon. (2001). Nutrition Almanac (5th Ed.). United States: McGraw-Hill Publishing Company.

Health Check
Please note that all fields followed by an asterisk must be filled in.
First Name*
Last Name*
E-mail Address*
City*
Country*
Home Phone
Protein
Tired/Fatigue
Sweet Cravings
Low Blood Sugar
Premature Aging
Muscle Weakness
Overweight
Slow Healing
Thinning Hair
Infections
Brittle Nails
Alcohol Cravings
Swollen Ankles
Poor Concentration
Hyperactivity
Muscle Injury
B Complex
Stress/Anxiety
Depression
Burning Feet
Fatigue
Thinning Hair
Hypoglycemia
PMS
Acne
Dark Circles
Nervous Tension
Dizziness
Epilepsy
Mood Swings
Grey Hair
Mental Confusion
Vitamin C
Bruise Easily
Bleeding Gums
Varicose Veins
Strokes
Colds/Flu
Infections
Poor Immunity
Stress/Anxiety
Sore Muscles
Slow Healing
High Cholesterol
Premature Aging
Blood Clots
High Blood Pressure
Poor Circulation
Vitamin E
Poor circulation
Cold hands/ feet
Strokes/Angina
Heart attacks
Miscarriages
Blood clots
Leg cramps
Infertility
Hot flushes
Smoking
Varicose veins
Bruising
Sore breasts
Breathing issues
Brown age spots
Hernias
Poor sex drive
Minerals/Zinc
Fluid retention
Headache/Migraine
Thyroid problems
Fatigue
Feels the heat
Loss taste/Smell
Acne/Dry skin
Poor appetite
Body odour
Infertility
Prostate problems
White marks(nails)
Salmon Oil
Arthritis
Aching joints
Poor memory
Inflammation
Migraines
ADD/ADHD
Prostate swelling
High blood pressure
Psoriasis
Asthma
High cholesterol
Low sperm count
Calcium/Magnesium
Osteoporosis
Menstrual cramps
Irregular heart beat
Muscle cramps
Insomnia
Growing pains
Backache
Nervousness
Tooth decay
PMS
Migraine
Bone/calcium spurs
Digestive Aids
Heart burn
Indigestion
Gastric reflux
Burping
Food allergies
Protein in blood
Bloating
Mouth ulcers
Diverticulitis
Constipation
Passing wind
Thrush/Candida
Weight Issues
Overweight
Obesity
Cravings
Diabetes
Tired/Fatigue
Slow metabolism
Excess hunger
Mood swings
Hypoglycemia
Lipids & Sterols
Tired/Fatigue
Wakes up tired
Hormone issues
Infections
Allergies
Toxicity
PMS
Premature aging
Arthritis
Carotenoids
Low immunity
Macular degeneration
Premature aging
Cataracts
Skin cancer
Infections
Light sensitivity
Lupus
Brown age spots
Vitamin A
Poor vision
Acne/Dry skin
Poor skin elasticity
Allergies
Bladder infection
Lung congestion
Sinus infection
Crohn’s disease
Mouth Ulcers

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