New! Iron Fuzion™ from Organic Curry Leaf Extract

General Health Questionnaire

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Use this Questionnaire to gauge your progress before and after cleansing.†

Fill this out before and 3 days after your first cleanse, and 3 days after your last cleanse.

Please let us know your results we love to hear from our customers!

Instructions:

  1. Print a copy of this questionnaire.
  2. Circle YES or NO to answer the questions.
  3. Fill in Your Score where indicated.
  4. Save this questionnaire to compare your results from before and after cleansing.

Today's Date: ______________________

Overall Well-Being

Consider Your Current Symptoms and Overall Sense of Well-Being and Answer:

Do You Feel Basically Healthy? YesNo
Do You Consider Yourself Happy? YesNo

List any negative health symptoms you're experiencing:

 

 

 

 

 

 

Do You Have Chronic Inflammation in Your Body?

If You Answer 3 or More Questions "YES" You May Have Chronic Inflammation.

Do you have elevated cholesterol or triglycerides? YesNo
Do you have numbness or tingling in your arms or legs? YesNo
Do you eat meat, commercially baked sweets, fried foods, or use vegetable oil daily? YesNo
Do you consume fish less than two times per week? YesNo
Do you have high blood pressure, asthma, or colitis? YesNo
Do you smoke? YesNo
Do you have gingivitis, periodontal disease, or not have regular dental cleansings and check-ups at least once every six months? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

Poor Nutrition and Lifestyle

Do You Have Poor Nutrition and Digestion?

If You Answer 4 or More Questions "YES" You May Have Poor Nutrition and Digestion.
Do you regularly include fast food in your diet (three or more times per week)? YesNo
Do you experience belching, bloating, or persistent fullness soon after eating, or do you experience excess gas often? YesNo
Do you experience heartburn or acid reflux two or more times per week? YesNo
Are you allergic to any specific foods? YesNo
Do you feel fatigued or lethargic after eating? YesNo
Do you commonly have bad breath or a bad taste in your mouth? YesNo
Do you use digestive aids such as laxatives, antacids, or acid-blocking drugs? YesNo
Do you often feel "older" than you should for your age? YesNo
Does your skin look sallow, gray, puffy, wrinkled, or aged? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

Do You Have Abnormal Blood Sugar Levels? Are You Pre-Diabetic or At Risk?

If You Answer 3 or More Questions "YES" You Could Have Abnormal Blood Sugar Levels.
Does your waistline extend beyond your hips or are you overweight? YesNo
Do you become tired or light-headed or do you feel the need to eat again just two or three hours after your last meal? YesNo
Do you eat dried beans e.g. pinto, navy, black, etc. less than three times per week? YesNo
Do you exercise less than three times each week? YesNo
Do you eat two or more servings of bread, pasta, candy, colas, or fruit juice a day? YesNo
Do you eat fewer than five servings of fresh, raw vegetables and fruits per day? YesNo
Do you have high blood triglyceride levels or suffer from hypertension? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

Do You Have Impaired Cellular/Mitochondrial Function?

If You Answer 3 or More Questions "YES" You May Have Impaired Cellular Function.
Are you frequently tired for no reason (especially around 3 P.M.)? YesNo
Do you have stiff and sore muscles (unrelated to recent exercise)? YesNo
Do you have poor stamina, shortness of breath, or feel exhausted after exercising? YesNo
Do you exercise less than two hours per week? YesNo
Have you ever been diagnosed with iron deficiency or do you have heavy menses? YesNo
Do you look older than your true age? YesNo
Have you ever been exposed to toxic chemicals or heavy metals? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

Exposure to Toxins

Is Your Detoxification Capacity Impaired?

If You Answer 4 or More Questions "YES" Your Body Needs Help to Detoxify.
Do you become physically ill when exposed to strong smells (perfume, auto-exhaust, cigarette smoke, etc.)? YesNo
Do you use chemical cleaners or solvents at home, at work, or in your hobbies? YesNo
Do you live in a house/apartment or work in an office less than 5 years old? YesNo
Do you have any amalgam (mercury) dental fillings? YesNo
Are you prone to side effects from medications or supplements, or have you become more sensitive to the effects of alcohol or caffeine (reduced tolerance)? YesNo
Do you have fewer than 2 bowel movements daily? YesNo
Do you smoke? YesNo
Do you have or have you ever had breast implants? YesNo
Do you have any pets, especially dogs, cats, birds, or other furred or feathered animals? YesNo
Do you wake up often during the night to urinate? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

Is Your Home and/or Work Environment Toxic?

If You Answer 4 or More Questions "YES" Your Home or Office Needs a "Health Makeover."
Do you have carpet in your home? YesNo
Do you vacuum less than 3 times per week? YesNo
Have you changed or cleaned your air filters in the last 30 days? YesNo
Do you routinely drink tap water? YesNo
Are your clothes and bedding washed in unfiltered city water? YesNo
Have you recently repainted your home on the inside? YesNo
Have you noticed any black spots or mold on your air vents or walls? YesNo
Have you had your air vents cleaned in the past year? YesNo
Do you use chemical based cleaners in your home? YesNo
Do you use chemical fertilizers, insecticides, or pesticides? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

Impaired Immune System

What is the Quality of Your Immune System Function?

If You Answer 4 or More Questions "YES" Your Immune System May be Overworked.
Do you catch colds or the flu easily? YesNo
Do colds, flu, or other infections tend to linger in your system more than 5 days? YesNo
Do you have a chronic cough, scratchy throat, sinus congestion, or excess mucous production making it necessary to clear your throat often? YesNo
Do you have seasonal allergies or known allergies to dust, animals, or mold? YesNo
Have you ever been diagnosed with an autoimmune disease? YesNo
Do you have dark circles under your eyes? YesNo
Do you have difficulty seeing at night, or do you have white spots on your fingernails? YesNo
Have you recently had any vaccinations? YesNo
Have you or anyone in your family served in the military in the last 15 to 20 years? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

Is Your Liver Impaired by Your Emotions?

If You Answer 5 or More Questions "YES" Your Liver May Be Impaired.
Do you feel angry from time to time? YesNo
Are you agitated easily? YesNo
Do you have frequent mood swings? YesNo
Is it hard to stay in a good mood? YesNo
Do you run out of energy during the day? YesNo
Do you have brown spots on your skin or age spots? YesNo
Does your skin break out or is it blemished? YesNo
Are your emotions often on a "roller coaster"? YesNo
Do you later have to apologize for your bad moods to friends, family, co-workers, etc.? YesNo
Is there always "something wrong" in your life? YesNo
Have you ever been physically or sexually abused? YesNo
If you are upset, is it best not to talk to you about what's going on? YesNo
Do you get annoyed by the "fake" cheeriness of others? YesNo
Do these questions irritate you? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

Are Your Kidney and Urinary Systems Functioning Properly?

If You Answer 5 or More Questions "YES" Your Kidneys May Be Overworked.
Do you have pain in your muscles and joints? YesNo
Have you had kidney or bladder infections in the last year? YesNo
Have you experienced ankle pain or swelling in the last year? YesNo
Do you have left shoulder pain? YesNo
Do your fingernails chip or break easily? YesNo
Do you have puffiness, "bags", or dark circles under your eyes? YesNo
Is your hair thinning? YesNo
Do you have frequent scalp irritations? YesNo
Do you have painful, harsh menstrual cycles? YesNo
Do you wake up often during the night to urinate? YesNo
Do you feel exhausted in the morning even after sleeping 8 or more hours? YesNo
Have you ever been diagnosed with thyroid problems? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

Do You Have Parasites, Viruses, Fungi, or other Microbes Inside Your Body?

If You Answer 4 or More Questions "YES" You May Need a Thorough Parasite Cleanse.
Do you have any yellowish discoloration on your fingernails or toenails? YesNo
Do you have athlete's foot or noticeable foot odor? YesNo
Do you have a history of yeast infections? YesNo
Have you been "mouthed", scratched, or licked by an animal in the last 6 months? YesNo
Have you been bitten by mosquitoes or bugs? YesNo
Do you feel bloated, grumpy, or gassy after meals? YesNo
Have you eaten at a sushi bar, salad bar, or buffet recently? YesNo
Have you ever picked food up off the floor and eaten it? YesNo
Do you often crave sugar, sweets, or bread? YesNo
Do you experience anal itching? YesNo
Do you have dandruff? YesNo
Do you have indoor pets? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

Hormonal Imbalance

Are Your Adrenal Glands Functioning Properly?

If You Answer 3 or More Questions "YES" Your Adrenal System May Be Suffering.
Do you frequently feel "stressed out"? YesNo
Do you have difficulty falling asleep or maintaining sleep through the night? YesNo
Do sudden noises make you jump? YesNo
Do you become dizzy or light-headed when standing up too quickly? YesNo
Do you crave salt or sugar? YesNo
Do you drink coffee? YesNo
Have you taken any diet pills in the last 3 years? YesNo
Do you drink any highly caffeinated beverages such as soft drinks or energy drinks? YesNo
Do you exercise less than 3 times per week? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

Is Your Thyroid Imbalanced?

If You Answer 4 or More Questions "YES" Your Thyroid May Be Imbalanced.
Are you frequently cold or do you have cold hands and feet? YesNo
Do you have trouble "getting going" in the morning? YesNo
Do you often feel sad or depressed, especially in the morning? YesNo
Are you unable to lose weight despite improving your diet and exercising more? YesNo
Do you have diffused or "patches" of hair loss from your head, arms, or legs? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

Are Your Sex Hormones Reduced in Production or Quality?

If You Answer 2 or More Questions "YES" Your Sex Hormones May Be Reduced.
Are you "flabby" or have you experienced a loss of muscle tone? YesNo
Do you suffer from a low sex drive? YesNo
Do you frequently experience headaches or migraines? YesNo
Do you have Pre-Menstrual Syndrome (PMS)? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

FOR WOMEN - Is Your Body Out of Balance?

If You Answer 6 or More Questions "YES" Your Body is Out of Balance!
Are you very easily fatigued? YesNo
Do you suffer from Pre-Menstrual Syndrome (PMS)? YesNo
Do you have painful menses (periods)? YesNo
Do you frequently experience depression before or during menstruation? YesNo
Is your menstrual cycle prolonged in duration or excessive in terms of blood flow? YesNo
Are your breasts overly sensitive or "painful" before, during, or after menses? YesNo
Do you menstruate too frequently (more than once per month or sporadic flow)? YesNo
Do you produce a vaginal discharge? YesNo
Have you had a hysterectomy or had your ovaries removed? YesNo
Do you have menopausal "hot flashes"? YesNo
Is your menses irregular or absent altogether? YesNo
Do you have acne or other skin blemishes that worsen during menses? YesNo
Have you felt depressed for 3 months or longer? YesNo
Do you have hair growth on your face or body? YesNo
Do you have or desire sex less than 2 times each month? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

FOR MEN - Is Your Body Out of Balance?

If You Answered 6 or More Questions "YES" Your Body May Be Out of Balance!
Are you very easily fatigued? YesNo
Do you have premature ejaculation? YesNo
Is urination difficult or do you "dribble" i.e. can't stop completely? YesNo
Have you experienced or are you experiencing prostate trouble? YesNo
Do you often wake up during the night to urinate? YesNo
Do you have pain on the inside of your legs or heels? YesNo
Do you have feelings of incomplete bowel evacuation or "not emptying fully"? YesNo
Do you have problems sleeping YesNo
Do you avoid even routine or mild physical activity? YesNo
Do you run out of energy during the day? YesNo
Do you experience leg nervousness or "twitching" at night? YesNo
Do you have difficulty falling asleep or maintaining sleep through the night? YesNo
Have you felt depressed for 3 months or longer? YesNo
Do you have or desire sex less than 2 times each month? YesNo

What is your score? Add up the number of "YES" and "NO" responses.

†Note — This General Health Questionnaire is not intended to diagnose, treat, cure or prevent any disease. No statements herein have been evaluated by the FDA nor is any endorsement thereof implied or given.

We advise use of this Questionnaire simply as a starting point for consideration of any negative health symptoms you may be experiencing and potential preventative measures or as a resource for further discussion with your healthcare provider.

These statements have not been evaluated by the Food and Drug Administration.
These products are not intended to diagnose, treat, cure, or prevent any disease.

All testimonials and product reviews are authentic from actual customers. Documentation is available for legal inspection. Product reviews are within range of typicality.

Information and statements made are for education purposes and are not intended to replace the advice of your treating doctor. Global Healing Center does not dispense medical advice, prescribe, or diagnose illness. The views and nutritional advice expressed by Global Healing Center are not intended to be a substitute for conventional medical service. If you have a severe medical condition or health concern, see your physician. This Web site contains links to Web sites operated by other parties. Such links are provided for your convenience and reference only. We are not responsible for the content or products of any linked site or any link contained in a linked site. Global Healing Center does not adopt any medical claims which may have been made in 3rd party references. Where Global Healing Center has control over the posting or other communications of such claims to the public, Global Healing Center will make its best effort to remove such claims.

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