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Children? If so, how many?

Occupation and how many hours do you work per week?

When was the last time you felt vibrant and well?

Other current major life concerns?

If you could wave a magic wand & change 2 things about your life right now, what exactly would they be?

Any serious illness, hospitalization, injuries, & surgeries either now or in your past?

How is the health of your mother? If deceased, relay illnesses.

How is the health of your father? If deceased, relay illnesses.

How is the health of your siblings? If deceased, relay illnesses.

Any ongoing sources of inflammation (e.g. eczema or other skin irritation, chronic post nasal drip, congestion, headaches, achy muscles/joints, swelling, pain, stiffness)?

How frequent is/was your cycle (how many days from start of one period to start of another)?

Explain if yes:

Birth control history:

Vaginal infections or reproductive concerns?

Which of the following do you struggle with: constipation, diarrhea, gas, distension, belching, bloating, or none of these?

Explain more about the above symptoms:

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