Click on the appropriate answer:
Do you catch colds or flu's easily?	Yes No
Do you tend to get sick more often during seasonal changes?	Yes No
Do you chill easily during weather changes?	Yes No
Do you bruise easily?	Yes No
Do you have thin, dull, or dry hair?	Yes No
Do you have a history of antibiotic use?	Yes No
Do you smoke or live with a smoker?	Yes No
Do you consume more than one alcoholic beverage per day?	Yes No
Do you consume more than two caffienated beverages per day?	Yes No
Do you frequently experience fatigue or irritability?	Yes No
Do you tend to have dry skin, acne, or rashes?	Yes No
Do you have bleeding gums when you brush your teeth?	Yes No
Do you get sick easily when adequate sleep is not obtained?	Yes No
Do you notice slow healing of injuries, cuts, or sores?	Yes No
Do you suffer from or have a history of allergies?	Yes No
Do you have poor night vision?	Yes No
Do you have diminished loss of taste or smell?	Yes No
Do you have frequent congestion, stuffiness, or coughing?	Yes No
Do you frequently experience swollen glands or itching of the throat, nose, eyes, or ears?	Yes No
Do you frequently have mucus drainage from the nose, throat, eyes, or ears?	Yes No

 

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