These questionnaires are designed to help you evaluate your personal health status. You may want to share your findings with your health provider or contact us to discuss your results.
If you would like to become a client of Well-Being Associates and have our clinical nutritionist design a Personal Wellness Program for you, please read general instructions below.
General Instructions for Clients
If you are filling out client questionnaires for the first time please click here to read about Indirect Testing and then print off a copy of all six (6) questionnaires listed below. Fill them out and mail along with all requested information to the address on the Contact Us page of this website.
If you are a returning client please contact Zoere’ for which questionnaires you will need to print off and fill out before being re-evaluated.
Click here to open questionnaire #1 -
Establish Your Health Goals
- health_goals.pdf / 19kb Adobe Acrobat Document
Click here to open questionnaire #2 -
Health History
- health_history_form.pdf / 58kb Adobe Acrobat Document
Click here to open questionnaire #3 -
Nutritional Assessment
- symptom-questionnaire.pdf / 29kb Adobe Acrobat Document
Click here to open questionnaire #4 -
Detoxification
- detox_questionnaire.pdf / 15kb Adobe Acrobat Document
Click here to open questionnaire #5 - Environmental Influences
- environmental_influences_form.pdf / 88kb Adobe Acrobat Document
Click here to open questionnaire #6 - Diet - Nutrition
- diet_nutrition_form.pdf / 99kb Adobe Acrobat Document
Click here to open questionnaire #7 - Sample Time Line History
- sampletimeline.pdf / 19kb Adobe Acrobat Document
Click here to open questionnaire #8 - Diet Diary
- diet_diary.pdf / 99kb Adobe Acrobat Document |
