Health Evaluation (60 second health test). Please fill out this sheet immediately! (Save this document to your computer first). When completed send it as an attachment to this email address: "ulkulju@yahoo.com". Name: Home Phone: Work Phone: Do you want a copy of the Toxic Colon Video Transcript? Mark your answer with X. Yes No Start Date: Personal Health Evaluation To start, indicate in the first column which of the following conditions apply to you in terms of frequency and/ or intensity of symptoms using x, xx, or xxx. This exercise will help you recall how you felt prior to starting the program and enable you to measure your progress. CONDITION PRESENT 14 DAYS 30 DAYS 60 DAYS 90 DAYS Low Energy/ Often Feel Tired ........ Skin Problems-Dry, Itchy, Acne ...... Headaches/ Migraines ............... Cuts and Bruises Heal Slowly ........ Aching Joints ....................... Muscle Cramps ....................... Menstrual Cramps/ Moody/ PMS ........ Difficulty Handling Stress .......... Subject to Colds and Infections ..... Poor Concentration ................. Strong Desire for Sweets/ Salts ..... High/ Low Blood Pressure ............ Frequently Take Pain Killers ........ Moods of Depression ................ Difficulty Getting Up in Morning .... Difficulty Falling Asleep ........... Cold Hands and Feet ................. Shortness of Breath ................. Often Feel Bloated .................. Bowel Gas ........................... Heartburn/ Indigestion .............. Constipation/ Diarrhea .............. Weak Fingernails/ Unhealthy Hair .... Poor Muscle Tone .................... Water Retention ..................... Cellulite ........................... Allergies/ Hayfever ................. Poor Night Vision ................... Varicose Veins ...................... Hemorrhoids ......................... PRESENT 14 DAYS 30 DAYS 60 DAYS 90 DAYS NOTE: If you are taking medication, consider consulting your doctor regarding taking these products. Always check product ingredients if you have food or other allergies. How many glasses of water do you drink each day? one ... two ... four ... five ... eight ... Do you consume coffee, tea, or pop daily? ... How many servings daily? ... Do you wish to lose weight? or gain weight? If so how much? ... For BEST RESULTS, make sure you read the Advanced Product Knowledge Booklet carefully to learn the correct use of our products.