Thank you for completing page 1 of your Health Questionnaire!  NOW COMPLETE PAGE 2 BELOW.

This is a great way to identify which vitamins, minerals, herbs, o other natural therapies are right for your body.  This is used for phone consultations with Jane Smolnik, Naturopathic Doctor, to make the most efficient use of our time together! 

 

We use a very sophisticated nutritional software program and analyze your test answers to identify which nutrients or supplements may be best for your body.  It’s the perfect way for you to know which nutritional supplements may be best for you!  

 

The way you answer each symptom question can give insight into nutritional deficiencies or needs you may have.

NOTE: If a question is asked more than once, please answer for every section.

You must complete ALL 3 pages!

 

Take your time and answer the questions as honestly as possible by rating each symptom with one of the following.

0- Never

1- Mild: occurs once a month or less

2- Moderate: occurs several times monthly

3- Severe: aware of it almost constantly