Balancing Body Chemistry Questionnaire

Before you open the questionnaire….

The Holistic Health Assessment is for face-to-face consultations only. If you purchased a hair test you DO NOT need to use this form.

Getting and staying healthy is a commitment of your time, energy and resources. The methods I use to assess your health status are designed to pinpoint where and why you are losing energy in your body systems.

Click on the form photo below to access the 8-page Holistic Health Assessment. Then click on INSTRUCTIONS – these instructions are for filling out the assessment form. Additional instructions are at the bottom of this page.

Print all documents. You will notice right away the health assessment is divided into sections that I will evaluate according to specific nutritional parameters, note deficiencies and/or excesses, and provide you with a plan for health and healing.

Nutrition plays an integral role in the healing process, in the prevention of illness, and in the optimal function of body. In order to focus on the nutritional aspects of holistic health, various nutrition assessment components are employed in order to plan and implement an accurate and effective protocol. It is very important you are ready for this commitment.

If you ordered a hair test you can expect your kit to arrive within 3-4 days from purchase. Results of your test will be returned to you within 2 weeks of mailing your hair sample to the lab (envelope and address provided in the lab order form). All instructions for cutting the hair sample are provided in the kit.

If you’ve purchase a face-to-face consultation and you are ready…

  1. Download and print the Health Assessment and INSTRUCTIONS.
  2. Complete the questionnaire – this will take time and will be worth it!
  3. Scan completed questionnaire
  4. Create a pdf and save it with your first name first and last name second
  5. Send completed questionnaire as a pdf to:


img003 Balancing Body Chemistry Questionnaire


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