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HEALTH QUESTIONNAIRE

Name, Surname *

Email Address *

How much water do you drink daily? *

What is your blood pressure? *

Do you have any skin rashes? *

Do you have regular daily bowel movements? *

Do you have any allergies or autoimmune diseases? *

Do you experience any pain? If yes, what hurts? *

Do you often wake up in the morning feeling low on energy? *

Are you taking any medications? If yes, what are they for? *

Are you prone to frequent illnesses? *

Do you experience herpes outbreaks (e.g., cold sores on your lips)? *

Do you have fungal infections in your body? *

Do you have pets at home? *

Briefly describe your health needs or concerns *

Phone number for a free consultation *

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