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Take Our Symptom Survey

Take Our Symptom Survey and Join Our Family!

Enjoyment is what life is about. We create cost effective tailor-made nutritional protocols. WE KNOW NUTRITION – let us make a free protocol for you that addresses the reason for your symptoms. There is no obligation to buy anything.  Get back to doing what you want to do! Let us handle the details.

Here’s How It Works:

1. Complete the Symptom Survey below

2. On the final page of the survey, sign up for your member account on this site. You will get an email with a link to set your password. BE SURE AND CHECK YOUR EMAIL FOR THIS MESSAGE.

3. Your personalized protocol won’t be ready right away. A nutritional counselor will analyze your confidential survey information and create a custom nutritional protocol – just for you. It can take a couple of business days.

Let’s get started!

PLEASE NOTE: Every survey is protected under HIPAA and is kept completely confidential. Your secure results will be evaluated by Dr. Jack or Mary, or one of our well-qualified nutritional consultants and shared only with you, as we set up your secure account online.

Step 1 of 8 - Yes! You are taking the survey! First some basic information...

  • MM slash DD slash YYYY
  • Please indicate which symptoms or issues you are experiencing below:
    Never symptoms - Never experience symptomsMild symptoms - Once or twice in the last 6 monthsModerate symptoms - Once or twice in the last monthSevere symptoms - Chronic, once, twice, or more in the last week
  • Group 1
  • Group 2
  • Same deal here. Please provide scoring values for all that apply:
    Never symptoms - Never experience symptomsMild symptoms - Once or twice in the last 6 monthsModerate symptoms - Once or twice in the last monthSevere symptoms - Chronic, once, twice, or more in the last week
  • Group 3
  • Group 4
  • Same deal here. Please provide scoring values for all that apply:
    Never symptoms - Never experience symptomsMild symptoms - Once or twice in the last 6 monthsModerate symptoms - Once or twice in the last monthSevere symptoms - Chronic, once, twice, or more in the last week
  • Group 5
  • Group 6
  • Same deal here. Please provide scoring values for all that apply:
    Never symptoms - Never experience symptomsMild symptoms - Once or twice in the last 6 monthsModerate symptoms - Once or twice in the last monthSevere symptoms - Chronic, once, twice, or more in the last week
  • Group 7a
  • Group 7b
  • Group 7c
  • Same deal here. Please provide scoring values for all that apply:
    Never symptoms - Never experience symptomsMild symptoms - Once or twice in the last 6 monthsModerate symptoms - Once or twice in the last monthSevere symptoms - Chronic, once, twice, or more in the last week
  • Group 7d
  • Group 7e
  • Group 7f
  • Same deal here. Please provide scoring values for all that apply:
    Never symptoms - Never experience symptomsMild symptoms - Once or twice in the last 6 monthsModerate symptoms - Once or twice in the last monthSevere symptoms - Chronic, once, twice, or more in the last week
  • Group 8
  • Same deal here. Please provide scoring values for all that apply:
    Never symptoms - Never experience symptomsMild symptoms - Once or twice in the last 6 monthsModerate symptoms - Once or twice in the last monthSevere symptoms - Chronic, once, twice, or more in the last week
  • Final Questions
  • This field is for validation purposes and should be left unchanged.
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