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Client Cellular-Level Evaluation

Please select your desired cellular-levels goals:

Digestive balance/comfortLower cholesterolWeight lossWeight gainIncreased energy

Select all that apply to you or your family:

DiabetesFood intolerancesHigh cholesterolHigh blood pressureBlood clottingObesityFibrosisAuto-immune diseaseArthritisRecent injury/surgeryChronic painOsteoporosisAnemiaCancerRadiation exposure

Select all medications that apply to you:

AntacidsLaxativesUlcer medAntibioticBlood thinnerHeart medBlood-pressureCortisoneAnti-inflammatoryOral contraceptiveHormone medRelaxant/sleeping pillThyroid medAnti-depressant

Select consumption (0 – never, 3 – sometimes, 5 – daily):









Select any cellular-level issues you may be experiencing:

Bloating/indigestion/gasConstipationDiarrheaOver-eatingSweets/sugar cravingsTiredness/fatiguePoor circulationFailing visionJoint pain/grinding/swellingEasy bruisingSlow recovery after you get sickMuscle crampsLight-headedness/headachesUrinary-tract painYellow discoloration in eyesAge spotsLack of concentration (brain fog)Irritability/anxietyHigh-stressBack pain near kidneysHeavy menstrual bleedingMonthly crampsFrequent colds/flu-like symptoms/infections