Wellness Test

* Name  (required field)
* Email Address (required field)
Phone Number
City
State
Zip

 

Occurs never or rarely
Occurs three to six times a week
Occurs twice a week or less
Occurs daily or several times a day
  • Before you take the test you will note as you go through the sections you will see over-lapping questions. It is necessary to answer all questions, even if they seem redundant.
  • Take your time and be honest in answering all the questions so that you will receive valid test results.
  • Click the button that best describes the LEVEL of your symptoms. If you do not know the answer to the question, do your best or leave it blank.
Section 1 Part A
1. Indigestion
2. Belching, burping
3. Gas immediately following a meal
4. Sense of fullness during meals
5. Poor appetite, picky eater
6. Difficult bowel movements
7. Difficulty swallowing
8. History of anemia, unresponsive to iron    
9. Vegetarian (no eggs, dairy)    
10. Spoon shaped nails    
11. Unintentional weigh loss    
12. Partial loss of taste or smell    
Section 1 Part B
1. Indigestion and fullness lasts 2-4 hours after eating
2. Pain, tenderness, soreness on left side under rib cage
3. Bloated
4. Excessive passage of gas
5. Abdominal cramps, aches
6. Nausea and/or vomiting
7. Specific foods/beverages aggravate indigestion
8. Roughage and fiber causes constipation
9. Three or more large bowel movements daily
10. Alternating constipation and diarrhea
11. Undigested food in stool
12. Mucus in stool
13. Dry, flaky skin, dry brittle hair    
14. Difficulty gaining weight    
       
Section 1 Part C
1. Stomach pain, burning, aching 1-4 hours after eating
2. Feeling hungry an hour or two after eating
3. Stomach discomfort, pain in response to strong emotions, thoughts, smell of food
4. Heartburn, especially when lying down, bending forward
5. Heartburn due to spicy and fatty foods, chocolate, peppers, citrus, alcohol, caffeine
6. Difficulty or pain when swallowing
7. Chest pain or infections, difficulty breathing
8. Experience relief from carbonated beverages, cream/milk/food
9. Constipation
10. Black, tarry stool
       
Section 1 Part D
1. Lower abdominal pain, cramping and/or spasms
2. Lower abdominal pain relief by passing stool or gas
3. Raw fruits, vegetables and stress aggravate bowel pain
4. Diarrhea (loose watery stool)
5. More than three bowel movements daily
6. Excessive gas and bloating
7. Painful, difficult, straining during bowel movements
8. Hard, dry or small stool
9. Extremely narrow stools
10. Alternating diarrhea/constipation
11. Mucus, pus in stool
12. Feeling that bowels do no empty completely
13. Bright red blood following bowel movement
14. Anal itching
Section 2 Part A
1. Moderate to severe pain under right side of rib cage
2. Abdominal pain worsens with deep breathing
3. Regurgitate bitter fluid
4. Bloated, full feeling
5. Belching, heartburn, gas
6. Fatty foods cause indigestion
7. Nausea or vomiting
8. Feel restless, agitated
9. Unexplained itchy skin worse at night
10. Stool color alternates from clay colored to normal brown
11. Feeling of poor health
12. Fatigue, weakness, exhaustion
13. Unable to concentrate, irritable, confused
14. Swollen feet and/or legs
15. Easy bruising
16. Feeling of extreme dryness
17. Reddened skin, especially palms
18. Dark urine, diminished flow
19 Dry, flaky skin, hair    
20. Yellowish cast to skin, eyes    
       
Section 2 Part B
1. Fatigue, sluggish
2. Feel cold (i.e. hands and feet)
3. Difficult, infrequent bowel movements
4. Dryness-skin, hair
5. Thick, brittle nails
6. Outer third of eyebrow thins
7. Puffy face, hands, and feet
8. Swollen upper eyelids
9. Eyeballs move involuntarily
10. Muscles weak, cramp and/or tremble
11. Slow mental processes, forgetfulness
12. Slow heart beats
13. Loss of appetite
14. Abdominal swelling
15. Unsteady gait, movements
16. Lack of interest in sex
17. Premenstrual tension    
18. Infertility    
19. Heavy menstrual bleeding    
20. Gain weight easily    
21. Swelling of the neck    
22. Thinning of hair on scalp, face, and genitals    
Section 3
1. Progressive, mild fatigue after exertion or stress
2. General weakness
3. Blurred vision, dizzy when rising
4. Depression
5. Rapid mood swings
6. Irritable, nervous
7. Dark circles under the eyes
8. Disinterest in food
9. Abdominal pain
10. Indigestion
11. Blotchy skin (white patches)
12. Tan skin, no sun
13. Black freckles on upper forehead, face, neck
14. Craving for salty foods
15. Gradual loss of body hair    
16. Sensitive to subtle changes in surroundings, weather    
Section 4 Part A
1. Generalized bone tenderness and achiness
2. Localized bone pain
3. Bone deformity or swelling
4. Shins hurt during or after exercises
5. Low back or hip pain
6. Limp, walking difficulties
7. Crunching or creaking sounds when move joints
8. Hands, feet, throat spasm, feel numb
9. Joint pain and stiffness- especially in spine, hips, knees
10. Hearing loss, headaches, ringing in ears
11. Established bone loss    
12. Calcium deposits    
13. Spinal curvature    
14. Recent loss of height    
15. Bow legs    
16. Stooped posture    
17. Hump at base of neck    
18. Unexplained bone fracture    
19. Tooth loss, gum disease    
Section 4 Part B
1. General muscle ache, pains
2. Localized muscle stiffness, tension, pain
3. Specific points on body feel sore when presses
4. Headaches
5. Fatigue, tired, sluggish
6. Difficulty sleeping
7. Feel unrefreshed upon awakening
8. Muscle weakness or loss
9. Difficulty speaking swallowing
10. Muscle cramps or spasm
11. Muscles twitch or tremble- eyelids, thumb, calf muscle
12. Irresistible urge to move legs
13. Legs move during sleep
14. Numbing, tingling sensation
15. Excessive joint mobility
16. Unable to fully straighten or extend legs and/or arms
17. Upper or lower back pain
       
Section 4 Part C
1. Joint stiffness, soreness
2. Red, swollen painful joints
3. Joint stiffness worsens with rest, improves with moving
4. Cracking joints
5. Shooting, aching, tingling pain down the back of leg
6. Joint pain involves one or a few joints
7. Joints hurt when moving or when carrying weight
8. Limited range of motion
9. Difficulty standing up from sitting position
10. Joint stiffness improves with rest, worsens with moving
11. Headache
12. Difficulty chewing food or opening mouth
13. Numbness, prickling tingling sensation in the neck, shoulder and arms
14. Involuntary muscle spasms
15. Deliberate movement with hands is difficult
16. Injure, strain, sprain easily
17. Discomfort or pain in neck, shoulder, or arm
18. Knobby overgrowths on the joints closest to the fingertips    
19. Double jointed    
20. One leg shorter than the other