Column 1 is a list of about 95 different symptoms listed in alphabetic order. Find the closest symptom that meets your patient s in this column.

Size: px
Start display at page:

Download "Column 1 is a list of about 95 different symptoms listed in alphabetic order. Find the closest symptom that meets your patient s in this column."

Transcription

1 Dear Health Care Provider, We at LazrPulsr system believe that the best form of health care is to start with the Foundational Health Care Procedure. This begins forming a more stable foundation for your health that you can build better health on. However we understand that this is not always possible and in an office environment many times you need to treat the primary complaint as soon as possible. Therefore we have created this therapy guide to help providers and patients develop the best therapies for any given condition. This Guide is specific for the LazrPulsr 4X Mk III Personal and Professional Health Care System. For the Mk III Home therapy systems please refer to the Mk III Home Therapy programs link on this site. How to use this Therapy Guide: Column 1 is a list of about 95 different symptoms listed in alphabetic order. Find the closest symptom that meets your patient s in this column. Column 2 is a list of numbers that relate to the nutritional supplements at the end of this guide. These Standard Process nutritional supplements directly support the selected symptom and were developed by Mark Anderson of Standard Process West. Utilize these nutrients or nutrients of equal quality for best results. They should be available from the Health Care professional that prescribed this therapy laser for your use. Column 3 list therapy programs that are contained in the Mk III Personal and Professional Therapy Laser that are directly related to the selected symptom. However, there can be many different causes for each symptom. So even though we tried to list these procedures in the typical order of priority, each patient is unique and the user should select the programs from this list that best fit the needs of each patient. This list utilizes 3 different types of programs that are found in the Mk III therapy system. Programs in Red are single frequency programs that should be run under the Chin for 10 min 1 time. Programs in Blue utilize a Therapy Card which has a homeopathic remedy imprinted on the magnetic strip found on the back side of the card. Run these programs as instructed on the Therapy Card while holding your left finger tips on the magnetic strip. These programs may be run without the Therapy Card but you will usually have diminished results. Programs in Black were developed for the Home Therapy System. These programs do not require an additional homeopathic remedy as the remedies are already imprinted into the laser itself. Therefore these programs do not come with therapy cards. Perform these programs as described in the Treatment Guide book 2. You can also find an image of all these programs in the Mk III therapy procedures link on our site. We hope that you find these therapy recommendations useful in your practice. Dr. Gerry Graham III President: LazrPulsr System

2 LazrPulsr 4X Mk III Therapy System ~ Custom Therapy Guide Programs #001 through #199 Run for 10 minutes each, Place Under Chin Programs #501 through #649 Run as instructed on the Therapy Card while holding the magnetic strip on the back of the card with your Left Finger tips. Programs #651 through #685 Run as described in Treatment Guide book 2 All recommendations are placed in approximate order of priority for each condition. Condition Nutrition Mk III Personal & Professional Therapy Programs Allergies 2, 3, 5 #658 Allergy Altitude Sensitivity 10, 9 #041 Pituitary Antibiotic use protect, & recovery Antihistamine, sneezing attacks 23, 22 3, 5 #037 Air Intolerance Anxiety 12, 25, 18 #536 Air Intolerance #674 Lung Health #187 Smoking 3 #577 Sleep Disorder Athletes Foot 51 Protocol Card All Autoimmune Run 2 times in 6 days Run 2 times a day for 10 days on Belly Button, then, 1 time a day for 1 month under chin. #017 Cleansing Run 20 Min a day for 10 days on Mid Chest Blood-clotting (increase) 13-P #033 Deep Bruise 2 Bone Bruise 6 #022 Bone #033 Deep Bruise 2 #542 Staph Infection Bone Repair 6, 7, 9, 13-P #604 All Bone/Aura #041 Pituitary #660 Fractures #021 Vascular HA #022 Bone #680 Arthritis #592 Osteoporosis

3 Brain: Mind, Mental, Cognitive, developmental Breast Milk Supply 19, 20, 33, 35 Breast Health scaring, surgery, Lymph Nodules Breathing Shortness of breath Bruising & capillary Fragility Bruxism (grinding of teeth) 28, 29, 12 #042 Thyroid Balance 43, 58, 55 #671 Glandular Health #033 Deep Bruise 2 #538 Cold Sore 9, 10 #674 Lung Health #037 Air Intolerance 17 #020 HA Toxic #047 Adhesions #027 Deep Wound 12, 7 #001 Low Back Bug Bites 11-P #664 Venomous Bites #542 Staph Infection Burns 13-O #047 Adhesions #662 Wounds #659 Burns #027 Deep Wound #652 Aura health #652 Aura health #007 Cranial Nerves #009 Category 1 #662 Wounds #041 Pituitary #034 Surgery #663 Surgery #003 N/M Re-Ed #664 Venomous Bites #033 Deep Bruise 2 #525 Heavy Metal #047 Adhesions #043 Liver Kidney #031 Open Wound 4 #539 Shingle Pain #631 Wrinkles 2 Candida 51 Protocol Card Sensitivity 1 x every 2 days for 12 days

4 Carbohydrate Digestion 23 Carpal Tunnel Syndrome 50 #572 Carpal Tunnel #653 Radiation Detox #680 Arthritis Chapped Lips 30, 38 Constipation 19, 23, 37, 38 #021 HA Vascular #039 Stomach-LI #537 Structural Balance 1 #649 Malnutrition B Cough 16, 7, 11-T #525 Heavy Metal Chronic Fatigue 16, 59, 34 #559 Spiritual Cleansing #560 Aura Attachment #651 Fatigue Recovery #604 All Bone/Aura #031 Open Wound 4 #593 CSF (Cerebral Spinal Fluid) Crohn s Disease 51 On Liver 2 times a day for 6 days Dark under eye circles 17, 12 Dermatitis 30, 31, 29 #605 All Cell Mutate #670 Diabetes #041 Liver/Kidney #031 Open Wound 4 #662 Wounds Diaper Rash 30, 7 #605 All Cell Mutate #597 Warts #037 Air Intolerance #041 Pituitary #637 Pancreas/Spleen Detox #536 Air Intolerance #674 Lung Health #652 Aura Health #671 Glandular Health Protocol Card Sensitivity Run one time wait 6 days and run again #033 Deep Bruise 2 #605 All Cell Mutate

5 Diarrhea 14 #584 All Fluids #010 Restore Digestive enzymes 32 Diuretic, edema, fluid retention 1 #584 All Fluids #645 Quick Trim 5 #039 Stomach LI Ear Infection 16 #017 Cleansing #668 Ear Health #021 HA Vascular #623 Meniers Eczema 30, 31, 29 #605 All Cell Mutate #047 Adhesions #042 Thyroid #535 Food Intolerance #576 Skin Lesions EMF 40, 43, 44 #653 Radiation Detox #530 Inflammation / NS #529 All Infections #537 Structural Bal 1 #525 Heavy Metal #011 Healing #628 Psoriasis #664 Venomous Bite #658 Allergy #186 Jet Lag #048 Radiation #037 Air Intolerance Fatigue 18, 27,9, 7 #651 Fatigue Recovery #042 Thyroid #186 Jet Lag #021 HA Vascular Fear 46, 45 Autoimmune Protocol #525 Heavy Metal #535 Food Intolerance #561 Body Reset

6 Female Balance 47 #671 Glandular health #648 Malnutrition A #516 Hormone Health Fever esp. children 7, 9, 11-T, 38 #038 Aura Health #522 Neurotoxins #515 CSF (Cerebral Spinal Fluid) #593 CSF (Cerebral Spinal Fluid) Flatulence & Bloating 32, 23 #670 Diabetes Food Poisoning Foreign Travel, gut protection Gallbladder distress (fats, oils) 14, 13-P, 23 #657 Headache #579 General Infection 14, 23, 32 #591 Colitis 4 #608 Fats / Oils Gastritis 21, 13-P #518 Digestive Health Gout 27, 1, 32 #025 Ligament #671 Glandular Health #590 Toxic Lymph Gums Bleeding 17, 13-P Hangover 1, 11-T #670 Diabetes Headaches 27, 17 #653 Radiation Detox #616 Connective Tissue #521 Reproductive Health #631 Wrinkles 2 #044 Female #042 Thyroid Balance #501 Mus/Skel Balance #626 Parasite Infection #529 All Infections #036 Food Intolerance #020 HA Toxic Allergy protocol #036 Food Intolerance #036 Food Intolerance #680 Arthritis #023 Burns #021 HA Vascular #031 Open Wound 4 #027 Deep Wound #027 Deep Wound #655 Maintenance #670 Diabetes

7 Heart Rate Rapid 26, 12, 29 #652 Aura Health #013 Heart #580 Organ Dysfunction Heart Rhythm 8, 29 #652 Aura Health #184 Lyme 5 Heart Burn 21, 32 #036 Food Intolerance #518 Digestive Health #524 Wounds All Hemorrhoids 15, 19 #021 HA Vascular #015 Liver #034 Surgery #530 Inflammation NS Hot Flashes 28, 31 #672 Hormone health #034 Surgery IBS 42 Run on Liver 2 times a day for 6 days Immune support 16, 7, 22 #593 CSF (Cerebral Spinal Fluid) Incontinence 48, 8 #501 Mus/Skel Balance #634 Spine Nerve Inflammation 29, 16, 7 #530 Inflammation NS Insect Bites 3, 13-O, 30, 33 #664 Venomous Bites Autoimmune Protocol #579 General Infection #024 Skin Muscle #559 Spiritual Cleansing #013 Heart #024 Skin Muscle #559 Spiritual Cleansing #671 Glandular Health Protocol Card Sensitivity Run 1 time, wait 2 days and run again #537 Structural Balance #636 Liver GB Detox #559 Spiritual Cleansing #047 Adhesions #041 Pituitary #590 Toxic Lymph #584 All fluids

8 Irritability 25, 12 #651 Fatigue Recovery #516 Hormone Health #522 Neurotoxins Ligament & Tendon support 24 #661 Strain/Sprain #047 Adhesions #670 Diabetes #673 Joint Health #025 Ligament #523 Adhesions/Scars Liver Congestion 4 #037 Air Intolerance #636 Liver GB Detox #531 Allergy Lymphatic Congestion 16, 7, 29 Male Balance 49 #671 Glandular health #516 Hormone Health Mono 11, 22 #501 Mus/Skel Balance #651 Fatigue Recovery #618 Mono Autoimmune protocol Morning Sickness (pregnancy) 39, 60 (as needed) Sensitivity Protocol Card #672 Hormonal Health Motion Sickness 50 #041 Pituitary #593 CSF (Cerebral Spinal Fluid) #533 Jet Lag #593 CSF #639 Kidney Brain Detox #193 Arachnoid 1 #654 Structural Balance #041 Pituitary #165 Fungus Toe 2 #605 All Cell Mutate #516 Hormonal Health #593 CSF #036 Food Intolerance #042 Thyroid Balance #501 Mus/Skel Balance #542 Staph Infection #658 Allergy Mucous & Phlegm Resp. 20 #536 Air Intolerance #674 Lung Health

9 Muscle cramps legs, back, Charley horse Nails brittle, week, breaking 11-T, 7, 11- P Nausea 51, 32, 52, 53 #042 Thyroid Balance #592 Osteoporosis 11-T #015 Liver #021 HA Vascular #033 Deep Bruise 2 #605 All Cell Mutate #048 Radiation #525 Heavy Metal Nerve Relaxation 12, 25 #018 Nerve Pain 1 #593 CSF (Cerebral Spinal Fluid) Nightmares 1, 12 Plantar Warts, Warts 9, 11-P, 7-T Protocol Card Allergy Run 1 time wait 3 days and run again PMS 7, 25, 1 #042 Thyroid #530 Inflammation NS Parasites/Amoeba 54 #001 Low Back #042 Thyroid #537 Structural Balance 1 #567 Gout #033 Deep Bruise 2 #010 Restore #530 Inflammation NS #591 Colitis #534 Structural Balance 2 #039 Stomach LI #664 Venomous Bites #513 Arachnoid #514 Dura Mater #019 Nerve Pain 2 #590 Toxic Lymph Sensitivity Protocol Run 1 time wait 3 days and run again Run 2 times a day for 6 days on Rt. Ear #593 CSF #031 Open Wound 4 #671 Glandular Health PECT (Physical, Emotional, Chemical, Trauma) 12, 11-T, 39, 40, 41, #037 Air Intolerance #501 Mus/Skel Balance #559 Spiritual Cleansing #560 Aura Attachment #561 Body Reset #671 Glandular Health #016 Brain #651 Fatigue Recovery

10 Poison Vines 26, 3 #605 All Cell Mutate #026 Scrape Wound #514 Dura Matter Radioactive Iodine Exposure 28 #033 Deep Bruise 2 #048 Radiation #653 Radiation Detox #593 CSF (Cerebral Spinal Fluid) Rosacea 55 #036 Food Intolerance #559 Spiritual Cleansing Scarring prevention 30, 31 #662 Wounds #047 Adhesions #523 Adhesions/Scars #524 All Wounds #590 Toxic Lymph Sensitivity Protocol #524 All Wounds #605 All Cell Mutate #020 HA Toxic #529 All Infections #542 Staph Infection #630 Metallic Elements #029 Scrape Wound Shoulder ROM Bursitis 27, 13-P #654 Structural Bal #629 Bursitis #673 Joint Health #025 Ligament #042 Thyroid #534 Structural Bal 2 #527 Strain/Sprain #571 Pain Management 2 #560 Aura Attachment #605 All Cell Mutate Sinusitis 33, 16 #678 Neuro health #011 Healing #529 All Infections Skin Dryness - scaling 30, 31, 29 #042 Thyroid #523 Adhesions/Scars #530 Inflammation NS Skin Itching 11-T, 7, 30 #664 Venomous Bite #031 Open Wound 4 #531 Allergy #638 Lung Colon Detox #047 Adhesions #539 Shingle Pain #662 Wounds #659 Burns

11 Skin Rash 3, 5, 30 #605 All Cell Mutate Autoimmune Protocol #525 Heavy Metals Sleep Aid 12, 7 #531 Allergy Sprains 24, 7, 29 #661 Strain/Sprain #561 Body Reset #042 Thyroid #527 Strain/Sprain Staph Infections 11, 9, 7, 16 #048 Radiation #559 Spiritual Cleansing #542 Staph Infection Stomach Upset 32, 21 #682 Flue/Virus #039 Stomach LI #518 Digestive Health #531 Allergy Stress 18, 12, 25 #522 Neurotoxins Sunburn 11-T, 30 #659 Burns #580 Organ Dysfunction Sun & heat sensitivity 11-T #021 HA Vascular Swimmers Ear 22, 23, 36 #590 Toxic Lymph #518 Digestive Health #638 Lung Colon Detox #654 Structural Bal #663 Surgery #577 Sleep Disorder #665 Sleep #671 Glandular Health #534 Structural Balance #571 Pain Management 2 #662 Wounds #653 Radiation Detox Intolerance protocol #637 Spleen Pancreas Dtox #658 Allergy #577 Sleep Disorder #634 Spine Nerve Sensitivity Protocol #534 Structural Balance 2 #584 All Fluids #031 Open Wound 4 #653 Radiation Detox #668 Ear Health

12 Swollen Extremities 1, 8, 38 #025 Ligament Autoimmune Protocol Teeth loose, caries, teething 6, 7 #673 Joint Health #648 Malnutrition A Tension Headaches 25, 12, 27 #657 Headache Tonsillitis 33, 22 Tooth Ache 56, 57, 9 #022 Bone #673 Joint health #524 All Wounds Tranquilizer Relaxer 12, 25 #655 Maintenance #530 Inflammation NS #573 Pain Management 3 Warts, Plantar Warts Wound Healing cuts etc. 9, 11-P, 7-T Protocol Card Allergy Run 1 time wait 3 days and run again 9, 13-O #039 Stomach LI #601 All Tissues/ Genes #524 All Wounds #528 Surgery Vertigo 22 #584 All Fluids #501 Mus/Skel Balance #514 Dura Matter #584 All Fluids #670 Diabetes #649 Malnutrition B #566 Toe Fungus #156 Pain 1 #037 Air Intolerance #540 HPV #019 Nerve pain 2 #661 Strain/Sprain #157 Pain 2 #640 Aura health Intolerance protocol Sensitivity Protocol #020 HA Toxic #665 Sleep Run 1 time wait 3 days and run again Run 2 times a day for 6 days on Rt. Ear Sensitivity Protocol #662 Wounds #529 All Infections #593 CSF #561 Body Reset #664 Venomous Bites

13 Virus 9, 42, 22 #011 Healing #529 All Infection #540 HPV Yeast Infestation 23, 5 #017 Cleansing Sensitivity Protocol #010 Restore #542 Staph Infection #006 CNS Stim Nutrition Product Uses ~ Standard Process labs Nutritional Recommendations created by Mark Anderson of Standard Process West 1 A-C Carbamide Natural diuretic for water retention and edema. Helps prevent and reduce hangovers. Nightmares and bizarre dreams. 2 Allerplex Systemic support for seasonal allergies affecting the upper respiratory system. 3 Antronex A natural antihistamine. Chew 4 or 5 at once during sneezing attacks. Reduces discharge and allergic skin rashes. Functionally enhanced with Cal-Amo (#5) or apple cider vinegar. 4 Betafood (or AF Betafood) Gallbladder related stress. Fats/oil digestion Lowers bile viscosity. Fat digestion sensitivity or nausea. Methyl donor source for fat metabolism, liver support. 5 Cal-Amo Normalizes high ph (alkalinity) so common in allergies, bursitis, infections, and joint pain. High ph increases pathogen growth. Functionally similar to apple cider vinegar. Contains acid-forming salts found in seawater. 6 Calcifood Wafers Complete protein food from raw veal bone and marrow. Source of all 22 amino acids. Endurance food for protein nutrition and ligament support. High-protein canine training treat. A powerful bone food. Chew or grind then swallow. 7 Calcium Lactate (Tablets or Powder) 8 Cataplex B (or Vasculin) All-important ionizable calcium for diffusion into tissue fluids. Rapid immune enhancement and muscle relaxation. Teething. Blended with magnesium in 5:1 ratio. Rapidly absorbed. 1 tbsp. = 20 tablets. Nerve stimulating B vitamin group. Increases nerve motor conductivity, innervation and electrical rhythm. Heart valve efficiency. Rhythm stability further enhanced with Tuna Omega-3 Oil (#29). 9 Cataplex C Collagen forming and building vitamin C complex. Collagen is the protein of ligaments, teeth, skin, and bone. Phagocytosis and immune response, infection, fever, wound healing. 10 Cataplex E 2 (or Cardio-Plus) 11 Cataplex F (T)Tablets Cataplex F (P) Perles Facilitates oxygen form blood into muscle. Oxygen deprivation is a cause of muscle spasm and fatigue. Resistance to altitude sickness. Muscle cramps tissue calcium starvation use with Calcium Lactate (#7). Use for resistance to sunburns. Sun and heat sensitivity (hypervitaminosis D hypercalcemia). 12 Cataplex G Nerve relaxing B vitamins. Vasodilator. Take with Min-Chex (#25), before bed as a sleep aid. Take with Organically Bound Minerals (#26) for panic; or solo for a gentle nerve relaxer or for tension headaches. Bruxism. 13 Chlorophyll Complex Ointment (O) Pearls (P) Ointment: Use for burns, wounds, and lesions. Will stain cover area. Anti-scaring vitamin E & A complexes and blood-clotting vitamin K. Perles: for faster clotting time and blood building effect of fat soluble chlorophyll. GI Tract inflammation. 14 Cholacol II Calcium bentonite clay used as adsorbent for food poisoning or gut toxicity and to dry up diarrhea. International travel combine with Zypan (#32) and Lactic Acid Yeast (#23). Functionally similar to activated charcoal. Take between meals on empty stomach. 15 Collinsonia Root Vascular tonicity and tension for hemorrhoids and varicose veins. 16 Congaplex General immune support. Protection against infections and colds. Lymphatic congestion. For acute care take every half hour Available as chewable for children.

14 17 Cyruta-Plus Anti-bruising. Leaking or burst capillaries. Skin under the eyes periocular area is a tenth as thick as facial skin. Capillary leakage there presents as dark circles. Bleeding guns is often a sign of capillary fragility. 18 Drenamin or Adrenal Desiccated 19 Fen-Cho or Whole Food Fiber (WWF) Anti-stress and chronic fatigue. Naturally energizes adrenals. Trauma, stress, and systemic overload. Adrenal Desiccated for short-term use and Drenamin for long-term support. For mild constipation, Fen-Cho is a natural stool softener and WFF is bulk-forming for intestinal motility and elimination. Take at bedtime and upon rising with a full glass of water. 20 Fen-Gre Expectorant. Blocks formation of mucous and phlegm in respiratory tract. Functional relief for lungs and bronchial tubes. Fenugreek has been used since ancient times to boost the milk supply when nursing. 21 Gastrex Relieves heartburn, gastritis, and nervous stomach symptoms, while soothing and promoting healing of ulcers. Best if taken 10 minutes before meals. 22 Immuplex Immune system rebuilding and restorative support after repeated infections and treatments. 23 Lactic Acid Yeast Wafers Produces probiotic lactic acid in the bowel to protect against pathogenic yeast and bacteria overgrowth. Promotes regularity and restoring GI flora and ph. Protects and restores bowel from oral antibiotics. 24 Ligaplex I Ligament and tendon injury; support for strains, sprains, tears, pulls, and hyper laxity of ligaments. 25 Min-Chex Natural physiological tranquilizer for minor shout-term depression, nervousness, irritability, PMS, and overall stress. 26 Organically Bound Min. (or Min-Tran) Potassium source and alkaline ash minerals from sea kelp and alfalfa supporting parasympathetic nervous system and heart function. 27 Phosfood Liquid Phosphorus for sympathetic nervous system support. Helps headaches, gout, bone spurs, bursitis, and tarter buildup on teeth. Often added to spark other protocols. 28 Prolamine Iodine Protein-bound organic iodine (plant protein) most readily absorbable from for hormone formation and cell utilization. Thyroid support. Vital for mental and cognitive development. Prenatal, infant and childhood brain development. Childhood cognitive function (along with Tuna Omega-3 Oil #29) 29 Tuna Omega-3 Oil Essential omega-3 oil rich in EPA and DHA fats for brain development, mood stability, healthy circulation, heart rhythm and vessel support. Sustainably sourced free of contaminants. 30 USF Ointment Topical thick salve of essential fatty acids for skin burns (sun, wind, or heat), diaper rash, dermatitis, eczema, chapped lips, dry skin. 31 Wheat Germ Oil Perles Swallow or chew perles for hair, skin, and nail health. Natural vitamin E complex and essential fats. Puncture and apply perle for topical use to prevent scarring or stretch marks. 32 Zypan Protein digesting enzymes (proteolytic pepsin and pancreatin) with hydrochloric acid, taken as digestive aid for gas and flatulence. Uric acid crystals, associated with gout, form from undigested protein. Essential gut protection for foreign travel. 33 Cataplex - ACP Supports Blood, Epithelial, Connective Tissues. General Resistance to infection. Skin disorders, eye conditions, Inflammation and Congestion. 34 Cyrofood Multiple vitamin and trace mineral product with raw veal bone. General nutritional, Fatigue & lowered resistance. 35 E Manganese Anterior Pituitary Disorders. Acute Ligament Injury 36 Garlic Encourages healthy circulation, liver function, and enhances immune system. 37 Okra-Pepsin Cleanse intestines and enhance gut absorption. Colitis, diverticulitis, ulcers. Malabsorption syndrome. 38 Water Artesian Spring water or Filtered, Reverse Osmosis or other quality filtration system 39 Inositol Diabetes mellitus related circulatory disorders. Muscular, nerve pain & degeneration. 40 Cruciferous Complete Supports cellular detoxification and health. Liver, Cellular detoxification and Eye health. 41 Catalyn Multiple vitamin, trace mineral, enzyme source. Twelve raw foods, cold processed and blended. 42 Lact-Enz Converts all carbohydrate to Lactic Acid. Acidification of GI Tract. Flatulence, halitosis, Toxemia, Malassimilation. 43 Whole Desiccated Spleen Source of SOD. Inflammation, Toxemia, Loss of intestinal flora, Immune system support. 44 Trace Minerals B 12 Spectrum of minerals including Iodine. Support Ligaments, Cartilage, Bone, Immune and Thyroid support. 45 Renafood Kidney detoxification and support. Kidney disease, Stones, Renal hypertension, Toxemia, Urinary Tract Inf.

15 46 Cataplex A Epithelial tissue support. Essential for eyes/retinal development and maintenance. Prevents night blindness (forms visual purple). Resistance to infection and inflammation. Essential for development of healthy mucous membranes. 47 Symplex F Supports the healthy function of ovaries, adrenal, pituitary, and thyroid glands 48 Ligaplex II Supports tissue and joints to maintain connective tissue health especially for long-term support. 49 Symplex M Supports the healthy function of the testes, adrenal, pituitary and thyroid glands. 50 B6 Niacinamide Supports protein and fat metabolism. Adrenal hormone precursor. Carpal Tunnel Syndrome, Numbness in extremities, Pregnancy edema. 51 Zymex Builds flora in the gut. GI Tract acidification. Kidney detoxification. Toxic Bowel. 52 Multizyme Proteolytic enzymes (pancreatin, fig, almond, pineapple) without HCL. Complete protein breakdown, Antiparasitic enzymes. 53 Gastrex Complex of Okra, montmorilinite clay and other absorbing, healing agents to sooth irritated GI tissue. 54 Zymex II Source of proteolytic enzymes for digestion of intestinal parasites. Contains no HCL. Flatulence, Protein digestion. 55 Cataplex E Promotes all cell repair. Increases tissue resistance to stress. Supports skin, muscles, ligaments, tendons. Specific support to cardio-vascular system. Anti-scaring, Pituitary imbalance, Sex hormone imbalances, Viral Infections. 56 Thymex Stimulates healing and defense mechanisms against bacterial and viral infections. Stimulates general thymus immune response. 57 Bio-Dent Supports bone, teeth, and related tissue structures. Protein, enzyme, mineral deficit. 58 Linum B6 Flax seed oil concentrate. Source of Omega 3 unsaturated fatty (especially linolenic) acid. Hair, skin, mail support. 59 Ferrofood Blood building anti-anemia factors. Red Blood Cell building support. Iron deficiency, Anemia, Pregnancy. 60 Choline Supports the Liver. Useful in Intestinal Colic, Intolerance to gas-producing foods, Nausea from fatty foods, Liver disease, Hypertension.

Column 1 is a list of about 95 different symptoms listed in alphabetic order. Find the closest symptom that meets yours in this column.

Column 1 is a list of about 95 different symptoms listed in alphabetic order. Find the closest symptom that meets yours in this column. Dear Home Health Care Provider, We believe that the standard 35 home programs, #001 through #035 along with the Foundational Health and GMO Recovery procedures will usually be sufficient for the majority

More information

Symptom Review (page 1) Name Date

Symptom Review (page 1) Name Date v2.4, 2/13 JonathanTreasure.com Botanical Medicine & Cancer Herb Drug Interactions Herbalism 3.0 Symptom Review (page 1) Name Date INSTRUCTIONS Please read each section below carefully and, after each

More information

DETOXIFICATION SUPPORT

DETOXIFICATION SUPPORT DETOXIFICATION SUPPORT with Jodi Cohen, NTP, Founder www.vibrantblueoils.com Key Points SUPPORT the detoxification organs BEFORE starting a detoxification program. This includes digestive healing efforts

More information

Apple Cider Vinegar Research has shown Apple Cider Vinegar cure high cholesterol, diabetes, sore throats and heart burn.

Apple Cider Vinegar Research has shown Apple Cider Vinegar cure high cholesterol, diabetes, sore throats and heart burn. Home Remedies Winter home remedy drink What you need: Ginger juice one cup Lemon Juice one cup Garlic Juice one cup Apple cider Vinegar one cup How to make: Crush ginger and garlic separately Squeeze to

More information

Nutrient Assessment Chart

Nutrient Assessment Chart Vitamin A Assessment Chart Chicken skin on backs of arms Chronic acne Dry eyes Food allergies Poor night vision Recurrent infections and colds Reduced hair growth in children Ulcers B Vitamins Afternoon

More information

Metabolic Assessment Form

Metabolic Assessment Form Metabolic Assessment Form Approach Wellness and Aesthetics 200 Forsythe Street Fayetteville, NC 28303 Office: (910) 322-7368 Fax: (910) 483-5796 www.tawellness.net Name: Age: Sex: Date: Part 1: Please

More information

Glencoe Health. Lesson 3 The Digestive System

Glencoe Health. Lesson 3 The Digestive System Glencoe Health Lesson 3 The Digestive System Health espotlight Video BIG IDEA The digestive system provides nutrients and energy for your body through the digestion of food. New Vocabulary mastication

More information

CAN I S Ay. A Guide To

CAN I S Ay. A Guide To CAN I S Ay that? A Guide To acceptable product claims Introduction Determining what we can and cannot say about NSP products can be confusing at times. This pamphlet is designed to provide NSP distributors

More information

Benefits of Ormus Minerals Fulvic Acid Minerals

Benefits of Ormus Minerals Fulvic Acid Minerals Benefits of Ormus Minerals Fulvic Acid Minerals Fulvic & Humic is unique, super-rich, and organically sourced proprietary formulation containing more than 74 trace minerals, 18 amino acids, and a super-

More information

J. Van Lier Ribbink, M.D., F.A.C.S. Center for Endocrine and Pancreas Surgery at Honor Health

J. Van Lier Ribbink, M.D., F.A.C.S. Center for Endocrine and Pancreas Surgery at Honor Health J. Van Lier Ribbink, M.D., F.A.C.S. Center for Endocrine and Pancreas Surgery at Honor Health Patient Clinical Information Questionnaire 1.0 Date of Questionnaire Completion; / / 2.0 Patient Data 2.1 Name:

More information

BACK TO BASICS HEALTH & NUTRITION COMPREHENSIVE HEALTH HISTORY

BACK TO BASICS HEALTH & NUTRITION COMPREHENSIVE HEALTH HISTORY BACK TO BASICS HEALTH & NUTRITION COMPREHENSIVE HEALTH HISTORY Thank you for choosing Back To Basics Health & Nutrition to assist you with your natural health care. The ability to draw effective conclusions

More information

SYMPTOMS THINGS TO TRY. Evaluation Report. Loss of Vitality (get up and go) Loose Skin (loss of collagen) Hair Loss. Poor Night Vision.

SYMPTOMS THINGS TO TRY. Evaluation Report. Loss of Vitality (get up and go) Loose Skin (loss of collagen) Hair Loss. Poor Night Vision. Evaluation Report Debra Debra 62 years oldfemale 215 pounds SYMPTOMS Loss of Vitality (get up and go) THINGS TO TRY *Wheat Grass Juice Powder Loose Skin (loss of collagen) This symptom is related to Low

More information

Sentelligent Medical Intuitive Body Scan

Sentelligent Medical Intuitive Body Scan Sentelligent Medical Intuitive Body Scan 1 1) Ask for presenting symptoms. Get clear channel and set sacred space. 2) Ask if any resistance or interference. 3) Ask Source to provide information only on

More information

What do you believe is causing your most important health concern?

What do you believe is causing your most important health concern? Intake form Name Today s Date Date of Birth Address City Phone Postal Code Email Primary Health Care Provider Emergency Contact Phone Note: By providing your email address you are giving us consent to

More information

Functional Blood Chemistry & CBC Analysis

Functional Blood Chemistry & CBC Analysis Functional Blood Chemistry & CBC Analysis Session 11 Immune Markers Immune Dysfunctions Immune Deficiency, Allergies, Immune Over Activity Causes of Immune Dysregulation External Influences Pharmaceutical

More information

Shiatsu Intake Form PURCHASED PRODUCT/SERVICE. Date of Birth Age Height Weight. Home Address City State ZIP

Shiatsu Intake Form PURCHASED PRODUCT/SERVICE. Date of Birth Age Height Weight. Home Address City State ZIP Shiatsu Intake Form DATE PURCHASED PRODUCT/SERVICE FIRST NAME LAST NAME Date of Birth Age Height Weight Home Address City State ZIP Home Phone Cell Phone Email Name of Emergency Contact Would you like

More information

Bodily Conditions Rooted in Hormone Imbalance

Bodily Conditions Rooted in Hormone Imbalance Check this list for all conditions that apply to you. The total possible score is 209. Count the number of symptoms you check. The higher your score, the more likely you need to address hormone imbalances.

More information

Amarillo Surgical Group Doctor: Date:

Amarillo Surgical Group Doctor: Date: Office Visit Information (General Surgery) Amarillo Surgical Group Doctor: Date: Patient s Information Name: Last First Middle Social Security #: Date of Birth: Age Gender: [ Male / Female ] Marital Status:

More information

Facial Assessment. Color. Lines in the Skin.

Facial Assessment. Color. Lines in the Skin. Facial Assessment Color. Red. Heat, inflammation, upward movement. White. Closure of capillaries, cold, shock, downward/inward movement. Blue. Lack of oxygen. Purple. Stagnation, bruises. Yellow. Liver,

More information

Medical History Form

Medical History Form Medical History Form Full Name Title: Mr/Mrs/Ms/Miss Address Date of Birth Date Telephone: Mobile: Email: How did you hear about the Garden of health? G.P s Name and Address Are you currently seeing your

More information

Digestion Assessment Scorecard

Digestion Assessment Scorecard Name Digestion Assessment Age Height Weight Based upon your health profile for the past 30 days, please select the appropriate number, from '0-3' on all questions (0 as least/never/no and 3 as most/always/yes).

More information

Nutritional Information

Nutritional Information Nutritional Information Fresh Green Chile Peppers The following information is for one serving of hot green chile peppers. That would be about one half cup of hot green chile peppers, or 75 grams. This

More information

THE MANY SYMPTOMS ROOTED IN HORMONE IMBALANCES

THE MANY SYMPTOMS ROOTED IN HORMONE IMBALANCES abdominal pain acne aging process accelerated allergies, including asthma, hives, rashes, sinus congestion anemia (blood hemoglobin low) anorexia anovulatory (no ovulation) anxiety anxious depression appetite

More information

SIBO

SIBO SIBO What is it? Small Intestinal Bowel Overgrowth A chronic bacterial infection of the small intestine Caused by bad bacteria such as E Coli and Clostridium migrating to the small intestine There is not

More information

Headache Follow-up Visit Form

Headache Follow-up Visit Form !1 Headache Follow-up Visit Form We will be unable to see you unless this form is completely filled out. We appreciate your thoroughness. Name DOB Age Today s Date Referring doctor: Primary doctor: Neurologist:

More information

Medical History Form

Medical History Form General: Medical History Form 1. Chief Complaint: What are the main health concerns you wish to address? 2. Current and Past Treatment: Have you received treatment for these problems? Yes No, if yes, which:

More information

Emotional Relationships Social Life Sexually Recreation

Emotional Relationships Social Life Sexually Recreation Name Date Address City State Zip Married Single Partner Divorced Widowed Date of Birth SS# Email Work Phone Home Phone Cell Phone Occupation Referred by Emergency Contact Family Physician Contact May we

More information

CONSULTATION ADMITTANCE FORM

CONSULTATION ADMITTANCE FORM CONSULTATION ADMITTANCE FORM Last Name: First Name: Address: City Postal Code: Home Phone: Work Phone: Age: Birth date (dd/mm/yr): Sex: M / F Height Weight Occupation: Alberta Health Care #: PLEASE CHECK

More information

! 30 E Padonia Rd, #305, Timonium, MD Phone: (410) Fax: (443)

! 30 E Padonia Rd, #305, Timonium, MD Phone: (410) Fax: (443) ! 30 E Padonia Rd, #305, Timonium, MD 21093 Phone: (410) 560-7404 Fax: (443) 705-0228 Email: info@waynebonliemd.com Today s Date: Patient Information Name: DOB: / / Address: City/Town: State: Zip: Home

More information

BROADWAY SPORTS & INTERNAL MEDICINE, P.S TH AVE NE SUITE 202 BELLEVUE, WA P: F:

BROADWAY SPORTS & INTERNAL MEDICINE, P.S TH AVE NE SUITE 202 BELLEVUE, WA P: F: BROADWAY SPORTS & INTERNAL MEDICINE, P.S. 1600 116 TH AVE NE SUITE 202 BELLEVUE, WA 98004 P: 206 215-2288 F:206 215-2289 MEDICAL HISTORY QUESTIONNAIRE Date Name Date of Birth HT WT Current Medical Complaints

More information

Digestion: Small and Large Intestines Pathology

Digestion: Small and Large Intestines Pathology Digestion: Small and Large Intestines Pathology Dr. Ritamarie Loscalzo Medical Disclaimer: The information in this presentation is not intended to replace a one onone relationship with a qualified health

More information

Medical History Form

Medical History Form Medical History Form NAME DOB / / TODAY S DATE MEDICAL HISTORY What medical Conditions do you have? Select all that apply, or write in if not listed: Diabetes High Blood Pressure Thyroid Disorder Heart

More information

My energy is lower than I would like it to. I feel exhausted after exercising or physical activity.

My energy is lower than I would like it to. I feel exhausted after exercising or physical activity. SYMPTOMS Questionnaire Duplicate your answer across all of the 5 boxes that aren t blocked out. See example ENERGY My energy is lower than I would like it to be. I feel exhausted after exercising or physical

More information

Intro to Vitamins, Minerals & Water

Intro to Vitamins, Minerals & Water Intro to Vitamins, Minerals & Water 1. What is the main function of vitamins and minerals? To regulate body functions 2. What foods are a lot of the vitamins and minerals we need found in? Fruits and Vegetables

More information

All product claims should be truthful, not misleading, and should be backed by scientific evidence.

All product claims should be truthful, not misleading, and should be backed by scientific evidence. SHARING YOUNG LIVING the Right Way The U.S. and most other countries have regulations in place designed to protect consumers. Many of these specifically regulate how natural wellness companies like Young

More information

Diana Quinn, ND Integrative Healthcare Providers 3053 Miller Rd Ann Arbor, MI P (734) F (734) New Patient Intake Form

Diana Quinn, ND Integrative Healthcare Providers 3053 Miller Rd Ann Arbor, MI P (734) F (734) New Patient Intake Form Diana Quinn, ND Integrative Healthcare Providers 3053 Miller Rd Ann Arbor, MI 48103 P (734) 547-3990 F (734) 547-3890 New Patient Intake Form Personal Information Name Age Sex Female Male Gender Identify

More information

TABLE OF CONTENTS. Introduction...5 What the Wrong Kind of Water...5 Benefits of Alkaline Water...8

TABLE OF CONTENTS. Introduction...5 What the Wrong Kind of Water...5 Benefits of Alkaline Water...8 TABLE OF CONTENTS Introduction...5 What the Wrong Kind of Water...5 Benefits of Alkaline Water...8 10 Reasons to Drink Alkaline Ionized Every Day...10 #1 Hydration...11 #2 Detoxification (Cleansing)...13

More information

Patient History Form

Patient History Form Patient History Form Advanced Directive Care Plan? Yes No Name: Birth date: / / Address: Age: Sex: F M STREET DAY YEAR Telephone: Home ( ) CITY STATE DAY YEAR MARITAL STATUS: Divorced Separated Alive/Age

More information

PLEASE COMPLETE ALL SECTIONS OF THIS FORM

PLEASE COMPLETE ALL SECTIONS OF THIS FORM PLEASE COMPLETE ALL SECTIONS OF THIS FORM Patient Name: Date of Birth: Referring Doctor? (Name, telephone number and address) Chief Complaint: Why have you come here? How did it start? What are the symptoms?

More information

VIPUL M DESAI

VIPUL M DESAI http://suratiundhiyu.wordpress.com/ VIPUL M DESAI SUGAR AND HUMAN BODY SWEET SICKER DINESH VORA [1] Sugar can suppress the immune system. [2] Sugar upsets the mineral relationships in the body. [3] Sugar

More information

Chapter 16. Human Anatomy

Chapter 16. Human Anatomy Chapter 16 Human Anatomy Each System we will examine: Structures types Problems or health concerns How to care for that system Skeletal System Made up of bones, joints, connective tissue Is the frame for

More information

Alivia Acupuncture Clinic, LLC. Address. City State Zip. . Occupation Employer. Emergency contact Relationship. Primary Care provider Phone

Alivia Acupuncture Clinic, LLC. Address. City State Zip.  . Occupation Employer. Emergency contact Relationship. Primary Care provider Phone Alivia Acupuncture Clinic, LLC Karla Sourasky Olmos, L. Ac Patient Information Name Age Date of birth Address City State Zip Email Home Phone Work phone Cell Phone Marital Status Single Married Divorced

More information

Essential Wellness Of Illinois, LLC Health History Questionnaire Christine A. Renz L.Ac., Dipl OM, MSTOM

Essential Wellness Of Illinois, LLC Health History Questionnaire Christine A. Renz L.Ac., Dipl OM, MSTOM Name Date Address City State Zip Home Phone Cell Fax Email Emergency Contact Emergency Number Date of Birth Age Sex Height Weight Lbs Marital Status Occupation Who referred you to this office? Name of

More information

The Human Body. Mrs. Green

The Human Body. Mrs. Green The Human Body Mrs. Green Bell Work Which of the following helps the body to cool down? a) Shivering b) Sweating c) Running a fever d) Taking a deep breath Which of the following is a function of the digestive

More information

New Patient Medical History Intake Form

New Patient Medical History Intake Form New Patient Medical History Intake Form Name: Todays Date: / / Date of Birth: / / Age: Gender: M / F Marital Status: S M D W Address: City: State: Zip Code Primary Ph.# (cell, hm, wk) Email Address 2nd

More information

Past Medical History. Chief Complaint: Patient Name: Appointment Date: Page 1

Past Medical History. Chief Complaint: Patient Name: Appointment Date: Page 1 Appointment Date: Page 1 Chief Complaint: (Please write reason, symptoms, condition or diagnosis that prompts your appointment) Past Medical History PERSONAL SKIN HISTORY YES NO Yes - Details Melanoma

More information

Questionnaire for Lipedema Patients

Questionnaire for Lipedema Patients Questionnaire for Lipedema Patients Name Date of diagnosis Date Name of physician making diagnosis Do you also have lymphedema? What areas of the body are affected? Outside of thighs Inner thighs Knees

More information

On a scale of 1 10 ("10" being optimal health) please rate where you feel your health is in the the areas below:

On a scale of 1 10 (10 being optimal health) please rate where you feel your health is in the the areas below: Healthcare History djp Pure-Health wellness centre www.pure-health.com Wellness Profile General Health On a scale of 1 10 ("10" being optimal health) please rate where you feel your health is in the the

More information

30 Days to Healthy Living And Beyond. Those who think they have no time for healthy living will sooner or later have to find time for illness

30 Days to Healthy Living And Beyond. Those who think they have no time for healthy living will sooner or later have to find time for illness 30 Days to Healthy Living And Beyond Those who think they have no time for healthy living will sooner or later have to find time for illness ARBONNE The Power of Plants Natural Healing Your body is created

More information

Nivolumab. Other Names: Opdivo. About this Drug. Possible Side Effects (More Common) Warnings and Precautions

Nivolumab. Other Names: Opdivo. About this Drug. Possible Side Effects (More Common) Warnings and Precautions Nivolumab Other Names: Opdivo About this Drug Nivolumab is used to treat cancer. It is given in the vein (IV). Possible Side Effects (More Common) Bone marrow depression. This is a decrease in the number

More information

I-ACT. Quarterly. International Association for Colon Hydrotherapy. Fall 2018 WHAT IS CANDIDIASIS? 2019 CONVENTION ANNOUNCEMENT

I-ACT. Quarterly. International Association for Colon Hydrotherapy. Fall 2018 WHAT IS CANDIDIASIS? 2019 CONVENTION ANNOUNCEMENT I-ACT International Association for Colon Hydrotherapy Quarterly Fall 2018 WHAT IS CANDIDIASIS? 2019 CONVENTION ANNOUNCEMENT THIS PDF DOCUMENT HAS BEEN SHORTENED FOR YOUR CONVENIENCE THE FULL PDF CAN BE

More information

INTRODUCTION METHOD OF WORK DEVICE FEATURES TIME OF USE

INTRODUCTION METHOD OF WORK DEVICE FEATURES TIME OF USE INTRODUCTION A unique wellness device that has no analogues in the world. It is necessary for every person to maintain a high level of health in the modern world. The device is used to contribute and protect

More information

Please answer all questions in blue or black ink by filling in the blank or circling. SOCIAL HISTORY

Please answer all questions in blue or black ink by filling in the blank or circling. SOCIAL HISTORY PATIENT QUESTIONNAIRE / ASSESSMENT Endocrinology Form Please answer all questions in blue or black ink by filling in the blank or circling. SOCIAL HISTORY Date Phone (H) (W) (C) Age Male Female Marital

More information

DHATU ASSESSMENT. Total the number of symptoms for each tissue category. 1. BLOOD PLASMA (RASA). The clear, serum portion of the blood.

DHATU ASSESSMENT. Total the number of symptoms for each tissue category. 1. BLOOD PLASMA (RASA). The clear, serum portion of the blood. DHATU ASSESSMENT Total the number of symptoms for each tissue category. 1. BLOOD PLASMA (RASA). The clear, serum portion of the blood. Excessively dry skin Dehydration Premature graying of the hair Cold

More information

Multivitamins are a mixture of vitamins and minerals which are essential for the body to work and stay healthy.

Multivitamins are a mixture of vitamins and minerals which are essential for the body to work and stay healthy. MULTIVITAMINS Multivitamins are a mixture of vitamins and minerals which are essential for the body to work and stay healthy. Vitamins are vital substances that are required for normal growth and functioning

More information

Condition #2: What is the next important condition you would like help with, and how long ago did it begin?:

Condition #2: What is the next important condition you would like help with, and how long ago did it begin?: NAME _ Please take the time to fill this form out completely. The more information we have, the better we can assist you, and will make better use of your initial visit. What is the main problem you would

More information

MARINE PHYTOPLANKTON NUTRITIONAL ANALYSIS

MARINE PHYTOPLANKTON NUTRITIONAL ANALYSIS MARINE PHYTOPLANKTON NUTRITIONAL ANALYSIS Element Description Importance for / Helps to / Promotes: Lacking of increase risk of: Alanine Amino acid Forms proteins Hipertension Muscle formation Diabates

More information

A Professional Dietary Supplement for the Promotion of Optimal Digestive Health

A Professional Dietary Supplement for the Promotion of Optimal Digestive Health A Professional Dietary Supplement for the Promotion of Optimal Digestive Health Unique SOQI Multi Energy Concept Unblock and Supply Provide cell membrane with negative potential energy and allows oxygen

More information

Biological Immunity Analysis

Biological Immunity Analysis Biological Immunity Analysis Indicators Brix Analysis (Sugars/Carbohydrates) Using a refractometer, we are able to measure the line of least resistance for light. Brix is the unit of measurement used to

More information

New Patient Form. Patient Demographics. Emergency Information. Employment Information. Page 1 of 7. Family Health Chiropractic Care

New Patient Form. Patient Demographics. Emergency Information. Employment Information. Page 1 of 7. Family Health Chiropractic Care Page 1 of 7 Patient Demographics First Name* Last Name* Date Of Birth* Home Phone* Mobile Phone Phone Gender* Email Preferred Communication Street Address 1* Street Addresss 2 Zip* City* State* Emergency

More information

Digestive System. Why do we need to eat? Growth Maintenance (repair tissue) Energy

Digestive System. Why do we need to eat? Growth Maintenance (repair tissue) Energy Digestive System Why do we need to eat? Growth Maintenance (repair tissue) Energy Nutrients Nutrient = chemical that must be obtained by an organism from it s environment in order to survive; nutrients

More information

Inner Balance Acupuncture

Inner Balance Acupuncture Patient Information Inner Balance Acupuncture 274 Southland Drive, Suite 101, Lexington, KY 40503 859-595-2164 www.acupunctureky.com Name: Today s date: Age: Male Female Marital status: Date of Birth:

More information

The benefits of THE EHM TECH Pendant

The benefits of THE EHM TECH Pendant The benefits of THE EHM TECH Pendant 1. EHM TECH Pendant expands capillaries It stimulates increased blood flow, regeneration, circulation and oxygenation. 2. EHM TECH Pendant is excellent for destocks.

More information

Chapter 15. Cardiovascular, Respiratory, Digestive Systems

Chapter 15. Cardiovascular, Respiratory, Digestive Systems Chapter 15 Cardiovascular, Respiratory, Digestive Systems Cardiovascular/Respiratory Systems Cardiovascular System Blood is pumped to the body 24/7 Heart s tasks: Carries oxygen from lungs to body cells

More information

Symptom Questionnaire

Symptom Questionnaire Symptom Questionnaire The following questionnaire is a general assessment of your health developed by Dr Royal Lee D.D.S. Each grouping represents a particular area of your body that may be causing you

More information

Hormone. for Women. Dr. Melanie MacIver, ND

Hormone. for Women. Dr. Melanie MacIver, ND Hormone Balancing for Women Dr. Melanie MacIver, ND Topics About hormones Benefits of balanced hormones Causes of hormone imbalance Bio-identical hormones Lifestyle and nutrition tips for balance Hormone

More information

what vitamins are what vitamins are for

what vitamins are what vitamins are for what vitamins are and what vitamins are for www.eurovit.eu page 1/23 Vitamins are essential for human body life. Vitamins are organic compounds that are needed in small quantities to sustain life. No vitamins

More information

Overview of AMINO ACIDS

Overview of AMINO ACIDS Overview of AMINO ACIDS Amino Acids are the chemical units or "building blocks" of the body that make up proteins. Protein substances make up the muscles, tendons, organs, glands, nails, and hair. Growth,

More information

LECOM Health Ophthalmology

LECOM Health Ophthalmology Patient Name: Date of Birth: New Patient Questionnaire Your answers will be used by your healthcare provider get an accurate history of your medical conditions and ocular concerns. If you are uncomfortable

More information

*Monitor for significant side effects, especially symptoms of neurological or cardiovascular events.

*Monitor for significant side effects, especially symptoms of neurological or cardiovascular events. Assessment Prior to administration: Obtain complete health history including allergies, drug history, and possible drug reactions Assess reason for drug administration such as presence/history of anemia

More information

Medical Information. (office use) MRN: CMRN: Last Name: First Name: Middle Initial: Date of birth: Age: Sex: M F Height: Weight:

Medical Information. (office use) MRN: CMRN: Last Name: First Name: Middle Initial: Date of birth: Age: Sex: M F Height: Weight: 1835 W. County Rd C, Suite 80, Roseville, MN 55113 P: 651-797-6880 F: 651-797-6881 info@spartzvein.com spartzvein.com Medical Information Date of consultation: (office use) MRN: CMRN: Last Name: First

More information

The Enzyme Deficiency Checklist

The Enzyme Deficiency Checklist The Power of Enzymes Without enzymes you could not exist. Enzymes trigger thousands of call to actions in the body that are necessary for you to survive. The Role of Enzymes If your body was a factory,

More information

Today s Date: What are your health goals? Symptom relief and preventing its return 100% optimum health and wellbeing on every level available to me

Today s Date: What are your health goals? Symptom relief and preventing its return 100% optimum health and wellbeing on every level available to me Today s : MHSC REGISTRATION # (6 DIGIT) (9 DIGIT) First Name: Last Name: I am a Male/Female (circle) Birthday (d/m/y): / / Current Age: Street Address: City: Province: Postal Code: Home #: Work #: Cell

More information

Digestive Care Advisor Training #1. Digestion 101 & H.O.P.E.

Digestive Care Advisor Training #1. Digestion 101 & H.O.P.E. Digestive Care Advisor Training #1 & H.O.P.E. The Digestive System in Brief The Process of Digestion The human digestive system is a complex series of organs and glands that process food and excrete waste.

More information

SYMPTOMS THINGS TO TRY. Evaluation Report. Dizzy when getting up too fast. Loose skin (loss of collagen) Hair loss. Poor night vision.

SYMPTOMS THINGS TO TRY. Evaluation Report. Dizzy when getting up too fast. Loose skin (loss of collagen) Hair loss. Poor night vision. Evaluation Report Patricia Patricia 78 years oldfemale 172 pounds SYMPTOMS Dizzy when getting up too fast THINGS TO TRY *Gallbladder Formula Loose skin (loss of collagen) Hair loss This symptom is related

More information

Medical Questionnaire

Medical Questionnaire MEDICIS Health Testing Center Avenue de Tervueren 236 115 Bruxelles Tel : 2/762.5.44 Medical Questionnaire Name :. Maiden name : First name :. Sex :. Address :...... Phone (private) : Office :. Date of

More information

Northeast Ohio Urogynecology Patient History Intake Form. Last Name First Name Age. Date of Birth Race Referring Physician.

Northeast Ohio Urogynecology Patient History Intake Form. Last Name First Name Age. Date of Birth Race Referring Physician. Northeast Ohio Urogynecology Patient History Intake Form Last Name _First Name Age_ Date of Birth Race Referring Physician Reason for Visit: _ Allergies: Preferred Lab (circle): QUEST LABCARE PLUS LABCORP

More information

WELCOME TO THE BURLINGTON NATURAL HEALTH CENTRE PLEASE FILL IN THESE FORMS AS COMPLETELY AS POSSIBLE. THANKYOU!

WELCOME TO THE BURLINGTON NATURAL HEALTH CENTRE PLEASE FILL IN THESE FORMS AS COMPLETELY AS POSSIBLE. THANKYOU! WELCOME TO THE BURLINGTON NATURAL HEALTH CENTRE PLEASE FILL IN THESE FORMS AS COMPLETELY AS POSSIBLE. THANKYOU! NAME DATE ADDRESS Gender CITY, PROVINCE HOME PHONE E MAIL POSTAL CODE DATE OF BIRTH (D/M/Y)

More information

Have you ever been diagnosed with any of the following? The patient has a history of the following conditions: Glaucoma

Have you ever been diagnosed with any of the following? The patient has a history of the following conditions: Glaucoma PALMETTO PHYSICAL MEDICINE 10 FINANCIAL BOULEVARD ANDERSON, SC 29621 PHONE (864) 437.8930 FAX (864) 309.8004 Have you ever been diagnosed with any of the following? Palpitation/Flutter Feelings Edema/Swelling

More information

SEVEN DAY TOTAL NUTRITIONAL CLEANSING PROGRAM

SEVEN DAY TOTAL NUTRITIONAL CLEANSING PROGRAM Cleansing & Detoxification SEVEN DAY TOTAL NUTRITIONAL CLEANSING PROGRAM With RevitalX and Detoxitech YOU CAN CHANGE YOUR LIFE! Gastrointestinal health Improved digestion Increased energy Protection from

More information

P A T I E N T H A N D B O O K

P A T I E N T H A N D B O O K PATIENT HANDBOOK Heal Your Gut, Heal Your Body The gastrointestinal (GI) tract is one of the most sophisticated systems of the human body. We often think of the GI tract for its primary role in digesting

More information

Bridges Family Wellness PC. New Patient Intake. Bridges Family Wellness Intake Form SE Lake Rd, Suite 102 Milwaukie, OR

Bridges Family Wellness PC. New Patient Intake. Bridges Family Wellness Intake Form SE Lake Rd, Suite 102 Milwaukie, OR New Patient Intake Bridges Family Wellness Intake Form Full Name: * What is your birthdate? MM/DD/YYYY * What is your gender identity? * Home address: * Cell Phone * Other Phone number(s): Emergency Contact

More information

REFLEXOLOGY HEALTH RECORD

REFLEXOLOGY HEALTH RECORD REFLEXOLOGY HEALTH RECORD THIS FORM IS TO BE COMPLETED BY THE CLIENT FIRST THEN BY PRACTITIONER FOR INITIAL SESSION Client Date of Birth Telephone Home Business Ext Email Address Street # City Street Name

More information

Introduction to Vibrational Balancing Images by Kat Miller

Introduction to Vibrational Balancing Images by Kat Miller 3-Mar-10 VBI Introduction www.hc.ehdef.com Page 1 of 8 Introduction to Vibrational Balancing Images by Kat Miller Vibrational Balancing Images are images that transmit vibrations for balancing and healing

More information

Candida stool test What is Candida? What causes Candida? What are the symptoms of Candida? Why take the test?

Candida stool test What is Candida? What causes Candida? What are the symptoms of Candida? Why take the test? Candida stool test What is Candida? Candida albicans can exist in a benign form in various parts of the body the skin, genitals and especially the digestive tract. It is an integral part of our body ecology.

More information

Omega 3. Kosher and manufactured under the supervision of Badatz Edah Hacharedit

Omega 3. Kosher and manufactured under the supervision of Badatz Edah Hacharedit Omega 3 These Omega 3 Fatty Acids are essential; our body does not produce them, therefore it must receive them from the food and from nutritional supplements. They are necessary for the optimal functioning

More information

AHI - New Patient Information

AHI - New Patient Information Personal Information Last Name First Name Middle Initial Address: Street Unit # City Province Postal Code Date of Birth (Day/Month/Year) Home Phone # Work Phone # Cell Phone # May the clinic leave you

More information

STRESS AND THE HEALTH OF THE BODY

STRESS AND THE HEALTH OF THE BODY Slide 1 STRESS AND THE HEALTH OF THE BODY Slide 2 What is Stress It is a physical response that occurs in our body when we are stressed Physiologically, it is a series of actions in the body that are regulated

More information

New Patient History. Name: DOB: Sex: Date: If yes, give the name of the physician who did your evaluation or ordered your tests:

New Patient History. Name: DOB: Sex: Date: If yes, give the name of the physician who did your evaluation or ordered your tests: New Patient History Name: DOB: Sex: Date: Chief Complaint: 1. Give a brief description of the problem you are seeking treatment for today: 2. Have you been evaluated for this problem or had any tests for

More information

Dr. Andrea Gri B.Kin, ND Doctor of Naturopathic Medicine Phone: Fax: Peter Robertson Blvd, Brampton ON L6R 1T4

Dr. Andrea Gri B.Kin, ND Doctor of Naturopathic Medicine Phone: Fax: Peter Robertson Blvd, Brampton ON L6R 1T4 Dr. Andrea Gri B.Kin, ND Doctor of Naturopathic Medicine Phone: 905-793- 8868 Fax: 905-793- 8957 630 Peter Robertson Blvd, Brampton ON L6R 1T4 ADULT INTAKE FORM Name: (Last) (First) (Preferred Name) Address:

More information

SYMPTOMS THINGS TO TRY. Evaluation Report. Loose Skin (loss of collagen) Hair Loss. Poor Night Vision. Salt Cravings. Allergies.

SYMPTOMS THINGS TO TRY. Evaluation Report. Loose Skin (loss of collagen) Hair Loss. Poor Night Vision. Salt Cravings. Allergies. Evaluation Report Louise Louise 52 years oldfemale 60 pounds SYMPTOMS Loose Skin (loss of collagen) THINGS TO TRY *Wheat Grass Juice Powder This symptom is related to Low Stomach Acid Hair Loss This symptom

More information

Welcome to About Women by Women

Welcome to About Women by Women Welcome to About Women by Women Today s Date New Patient Questionnaire Name: Birth Date: / / Home Phone: Address: Cell Phone: Work Phone: Occupation: Employer: Marital Status: Married Living w/ Partner

More information

CIE Biology GCSE 7: Human nutrition

CIE Biology GCSE 7: Human nutrition CIE Biology GCSE 7: Human nutrition Notes Humans need many different nutrients to survive. To receive these nutrients in the correct quantities, a balanced diet must be eaten. A balanced diet includes

More information

MULTI-SYSTEMIC INFECTIOUS DISEASE SYNDROME SYMPTOM QUESTIONNAIRE

MULTI-SYSTEMIC INFECTIOUS DISEASE SYNDROME SYMPTOM QUESTIONNAIRE MULTI-SYSTEMIC INFECTIOUS DISEASE SYNDROME SYMPTOM QUESTIONNAIRE SECTION 1: SYMPTOM FREQUENCY SCORE Select the frequency of each of the following symptoms. 0 = None 1 = Mild 2 = Moderate 3 = Severe 1.

More information

*542686* How severe is the problem? mild moderate severe Is it getting better or worse? Better Worse Same over the last hours days weeks months

*542686* How severe is the problem? mild moderate severe Is it getting better or worse? Better Worse Same over the last hours days weeks months *542686* Referring Doctor Name: Specialty: City: State: Primary Doctor Name: Specialty: City: State: Instructions: On the body drawing below, please show where you feel pain at this time. Please mark only

More information

Premium Specialty: Pediatrics

Premium Specialty: Pediatrics Premium Specialty: Pediatrics Credentialed Specialties include: Adolescent Medicine, Pediatric Adolescent, and Pediatrics This document is designed to be used in conjunction with the UnitedHealth Premium

More information

FULVITE a fulvic acid tonic by JESU-RAPHA

FULVITE a fulvic acid tonic by JESU-RAPHA FULVITE a fulvic acid tonic by JESU-RAPHA Nutritional, mineral and remedial tonic derived from ancient plants 15% fulvic acid concentration, manufactured exclusively for Rapha using a unique process An

More information

Name: Date of birth: Address: City: State: Zip: Phone: (day) (evening): (cell): address: Occupation: Who referred you/how did you hear about us?

Name: Date of birth: Address: City: State: Zip: Phone: (day) (evening): (cell):  address: Occupation: Who referred you/how did you hear about us? Name: Date of birth: Address: City: State: Zip: Phone: (day) (evening): (cell): Email address: Occupation: Who referred you/how did you hear about us? Your primary health care provider: Phone: Emergency

More information

PATIENT MEDICAL HISTORY PATIENT INFORMATION

PATIENT MEDICAL HISTORY PATIENT INFORMATION PATIENT MEDICAL HISTORY PATIENT INFORMATION Name: Referred here by: Self Family Friend Doctor Other Health Professional If Doctor, please give name & address: List doctors seen in the last 24 months: Relative(s)

More information