I am so glad you are here. 
Let's check your 
Symptoms 

Please tell me a little more about your symptoms so I can
help assess your current need for restoration. 


Symptom Checklist


Your symptoms are your body's way of speaking to you. I always say, "Compare your symptoms to a toddler that is trying to communicate, but has no words. They grunt, point, and often shout in frustration because they are misunderstood." 
By understanding this, you can begin to listen more closely to what your body is trying to tell you, helping you address your health more effectively.



First Name*
Last Name*
Email*
Phone*
Digestive Tract Symptoms *
Ear Symptoms *
Emotional Symptoms *
Energy & Activity Symptoms*
Eye Symptoms *
Head Symptoms *
Joint & Muscle Symptoms *
Lung Symptoms *
Mental/mind Symptoms *
Mouth & Throat Symptoms *
Nasal Symptoms *
Skin Symptoms *
Weight Symptoms *
Other Symptoms *
During the past 30 days have these symptoms prevented you form getting a good nights sleep? *
If yes, which symptoms?
How many nights?
During the past 30 days have these symptoms affected your performance at work?*
If yes, which symptoms?
How many days?
During the past 30 days have these symptoms caused you to call in sick to work?*
If yes, which symptoms?
How many days?
During the past 30 days have these symptoms caused you to leave work early?*
If yes, which symptoms?
How many days?
Do you or your family have a history of allergies?*
Have you ever been tested for allergies? *
Do you have allergic reactions within 15 minutes or sooner after exposure to particular topical, ingested, or inhaled substances such as:*
Other*
Have you ever had a severe (anaphylactic) reaction?*
If yes, which substances cause the reaxtion?

Thank you so much for your time, 
I appreciate you. 


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Copyright tanya candee