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Wellness Center Questionnaire

For Research Purposes Only

NOTE: The purpose of The Greatest Physician's Wellness Center to help each visiting guest increase his or her healthy service to mankind and to help each visitor to feel more energetic and thus have a happier and more productive life. We achieve this by offering suggestions based on the Ten Commandments to Wellness found in the Holy Bible and shared as Road-Maps to Wellness. When the suggestions in the Road-Maps to Wellness are followed and the person responds favorably, this will show up on the visiting guest's sense of well being. Nothing we suggest is to diagnose or treat any disease or medical condition.

Answer the questions below with a Yes or No and please offer any specific explanations you can give. Although we do not use this information for diagnosis nor to treat any of the specific problems you may describe yourself as having, we like to know if there are any positive or negative changes to what you answer below after you have followed the suggestions in the Road-Maps to Wellness that will be provided to each person. This information could prove helpful in the future should mainstream medical practitioners choose to implement diet and lifestyle recommendations in their allopathic practices.

1. Do you have physical weaknesses?
Yes No     Comment:
2. Do you lack stamina?
Yes No     Comment:
3. Do you have pain in the joints?
Yes No     Comment:
4. Are you overweight?
Yes No     Comment:
5. Have you had any loss of weight in the last six months?
Yes No     Comment:
6. Have you had any operations?
Yes No     Comment:
7. Do you have a tendency to be anemic?
Yes No     Comment:
8. Do you know your red blood cell count?
Yes No     Comment:
9. Do you know your white blood cell count?
Yes No     Comment:
10. Do you know your platelet count?
Yes No     Comment:
11. Do you have chronic fever?
Yes No     Comment:
12. Do you have rectal itching?
Yes No     Comment:
13. Does your nose itch?
Yes No     Comment:
14. Do you have seizures?
Yes No     Comment:
15. Are you forgetful (long term memory)?
Yes No     Comment:
16. Are you absent-minded (short term memory)?
Yes No     Comment:
17. Do you have headaches?
Yes No     Comment:
18. Is your hair dull (lack of sheen)?
Yes No     Comment:
19. Are your pupils enlarged?
Yes No     Comment:
20. Do you wear glasses?
Yes No     Comment:
21. Do you wear contacts?
Yes No     Comment:
22. Do you have dimness of vision?
Yes No     Comment:
23. Do you have cataracts?
Yes No     Comment:
24. What is the color of your teeth?
Yes No     Comment:
25. What is the color of your gums?
Yes No     Comment:
26. Are your gums receding?
Yes No     Comment:
27. Do you have cavities or fillings?
Yes No     Comment:
28. Are your teeth glassy at the ends?
Yes No     Comment:
29. Are they rough on the edges?
Yes No     Comment:
30. Do you have athletes foot?
Yes No     Comment:
31. Do you have numbness of hands or feet?
Yes No     Comment:
32. Do you have cold hands or feet?
Yes No     Comment:
33. Is your skin abnormally discolored?
Yes No     Comment:
34. Is your skin oily?
Yes No     Comment:
35. Is your skin dry?
Yes No     Comment:
36. Do you have any reddish, scaly patches of skin, rashes or psoriasis?
Yes No     Comment:
37. Are you bothered by jock itch?
Yes No     Comment:
38. Is your appetite poor?
Yes No     Comment:
39. Do any foods upset your system?
Yes No     Comment:
40. List the foods that upset your system:
Yes No     Comment:
41. Are your bowel movements regular?
Yes No     Comment:
42. How often do you have a movement?
Yes No     Comment:
43. Do you ever have any pain or rectal bleeding with your movements?
Yes No     Comment:
44. Is your tongue coated?
Yes No     Comment:
45. Is your tongue dry?
Yes No     Comment:
46. Is your tongue hot?
Yes No     Comment:
47. Is the color of your tongue other than pink?
Yes No     Comment:
48. Do you have muscular pains?
Yes No     Comment:
49. Do the pains travel or move around?
Yes No     Comment:
50. Do you have pain in the legs?
Yes No     Comment:
51. Do you have pain in the lower back (especially after sitting or riding)?
Yes No     Comment:
52. Do you sleep soundly?
Yes No     Comment:
53. Do you wake up several times throughout the night?
Yes No     Comment:
54. Do you wake up rested and refreshed in the morning?
Yes No     Comment:
55. How many hours of sleep do you average each night?
Yes No     Comment:
56. Do you exercise?
Yes No     Comment:
57. How often do you exercise?
Yes No     Comment:
58. What form of exercise do you do?
Yes No     Comment:
59. How many cigars do you smoke?
Yes No     Comment:
60. How many cigarettes do you smoke?
Yes No     Comment:
61. How long have you been smoking?
Yes No     Comment:
62. Do you use drugs or hallucinogens?
Yes No     Comment:
63. Do you use hormones?
Yes No     Comment:
64. Do your use oral insulin?
Yes No     Comment:
65. How often do you take the oral insulin?
Yes No     Comment:
66. How long have you used oral insulin?
Yes No     Comment:
67. Do you use injected insulin?
Yes No     Comment:
68. Are you currently using medications?
Yes No     Comment:
69. Are you currently using any vitamin/mineral/herb food supplements?
Yes No     Comment:
70. Do you eat breakfast?
Yes No     Comment:
71. What do you eat for breakfast?
Yes No     Comment:
72. How often do you eat breakfast?
Yes No     Comment:
73. Do you eat lunch?
Yes No     Comment:
74. What do you eat for lunch?
Yes No     Comment:
75. How often do you eat lunch?
Yes No     Comment:
76. Do you eat supper?
Yes No     Comment:
77. What do you eat for supper?
Yes No     Comment:
78. How often do you eat supper?
Yes No     Comment:
79. Do you eat snacks between meals?
Yes No     Comment:
80. Do you drink coffee?
Yes No     Comment:
81. How many cups of coffee per day do you drink?
Yes No     Comment:
82. Do you drink coffee with caffeine or decaf?
Yes No     Comment:
83. Do you drink tea?
Yes No     Comment:
84. How often and how much tea do you drink?
Yes No     Comment:
85. What kinds of tea do you drink?
Yes No     Comment:
86. Do you drink soda pop?
Yes No     Comment:
87. How often and how much soda pop do you drink?
Yes No     Comment:
88. Do you use chocolate?
Yes No     Comment:
89. How much chocolate and in what form?
Yes No     Comment:
90. Do you use alcoholic beverages?
Yes No     Comment:
91. How often do you drink alcoholic beverages?
Yes No     Comment:
92. What kind of alcoholic beverages do you drink?
Yes No     Comment:
93. Do you add salt to your food?
Yes No     Comment:
94. How much and how often do you add salt to your food?
Yes No     Comment:
95. Do you ever crave any foods?
Yes No     Comment:

And Finally . . .

Your Full Name:
Your Email Address:
Required so we can email you your Roadmap to Wellness
IMPORTANT! Please read carefully...
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See also:
God's Answer
2 Cancer





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