Health Questionnaire

Do you feel run down? Tired and fatigued? This questionnaire was designed to see if it is possiable if Vitamin and Mineral deficiency is the cause! Originally written by Dr. Louie Yu.

Do you have too much stress? Hard to sleep at night? This questionnaire was designed to see if it is possiable if Vitamin and Mineral deficiency is the cause! Originally written by Dr. Louie Yu.

Created by: HRC of Health Restoration Center
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  1. On average, do you eat fewer than five fruit and vegetable servings per day?
  2. Do you often experience a scaly, flaky, seborrheic condition at the outer nose margins above the lips?
  3. Do you have soft nails or nails that chips, crack, or peel easily, and/or are brittle or contain ridges (rather than being smooth)?
  4. Are there white spots under your fingernails?
  5. Have you noticed small red spots under your skin?
  6. Has your skin been damaged by sunlight and/or do you use a tanning bed more than once per month?
  7. On average, do you consume more than three alcoholic beverages per week?
  8. On average, do you drink more than two cups of coffee or caffeinated tea (of any kind) per day?
  9. Are you a smoker?
  10. On a scale of one to five, is the daily stress level in your life three or greater , if one is a low level of stress and five is the highest level?
  11. Do you often experience cracks at the margins of your lips?
  12. Do you often experience a sore or burning tongue?
  13. Have you experienced a reduced ability to taste food?
  14. Do youy gums bleed easily?
  15. Do you bruise easily?
  16. Are you a slow healer from bruises and cuts?
  17. Do you feel chronically tired?
  18. Do you have irregular eatin patterns?
  19. Are you on a weight-loss or calorie-restricted diet (less than 2000-2500 calories per day)?
  20. Do you feel run down and/or are you experiencing a weakenede state of immunity?
  21. Does your hair fall out easily, and/or is it dry and brittle, and/or does it lack optimal lustre and sheen?

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