Health Assessment
Introduction
The Health Assessment Questionnaire is approximately 145 questions specifically designed to help pinpoint any functional problems. These may include:

  • Vitamin and mineral deficiencies
  • Hormonal Imbalances
a. Hyperthyroidism
b. Hypothyroidism
c. Blood sugar imbalances
d. Female menstrual imbalances
  • Adrenal gland fatigue
  • Digestive Problems
a. Leaky Gut Syndrome
b. High stomach acid (Hyperchlorhydria)
c. Low stomach Acid (Hypochlorhydria)
d. Food allergy possibilities
e. Fungal (Candida) possibilities
  • And many more.


Fax: 303.799.3695

Other Intake Forms:
Please give yourself 15 minutes or so to complete the online questionnaire. There is room for additional comments at the bottom of the assessment. For the online form, if the answers are not lined up with the questions (some browsers don't work as well), click the BACK button and print the form below. If possible, fax it ahead of time to 303.799.3695.