Parasite Questionnaire

This questionnaire is confidential! The questions that you answer and the results of this test will only be seen by you and are not sent to our office nor will be reviewed by our office. Each response that you give will be assessed by our exclusive Health Evaluation Program and your results will be given at the conclusion of this test. Please feel free to contact our office if you have any questions or would like additional assistance with your results.

The questions on this test are simple Yes or No questions. Answer "yes" if the question applies to you...Answer "no" if it does not.
Ath the end Click on Get my results ... to get your results.

Your Name

Yes

1.) Do you often feel bloated or have a lot of gas no matter what you eat?

2.) Do you feel burning or cramping in your intestines for no apparent reason?

3.) Do you feel tired often or even for most of the time?

4.) Do you get colds, flus and acute illnesses easily?

5.) Do you have digestive problems (gas, bloating, constipation, diarrhea) that come and go?

6.) Do you have food sensitivities or environmental allergies?

7.) Do you have difficulty losing or gaining weight?

8.) Do you have abdominal symptoms or diarrhea after visiting a foreign country or another part of the U.S.?

9.) Do you have a recurring feeling of not being well?

10.) Do you feel that something is just not right even though you've tried various nutrition programs?

Place a check box by each of the symptoms that you have had in the last 3 months

Abdominal pain	Constipation	Puffy face	Rashes
Allergies	Blurred vision	Indigestion	Ulcers
Anemia	Coughing	Nausea	Insomnia
Anorexia	Chest Pain	Night Sweats	Cancer
B12 deficiency	Heart Disease	Nervousness	Weight Loss
Diarrhea	Dizziness	Irritability	Weight Gain