Nutrient Survey Sample Questions

This is an example of one set of Nutrient Survey questions that are answered by your client. The client places checkmarks in front of those questions that apply to him/her and enters the total number of checkmarks in the total for the part number.

1. _______ Do you have cold hands & feet?
2. _______ Are you extremely uncomfortable when it is quite cold?
3. _______ Would you like to be able to take a nap in the middle of the afternoon?
4. _______ Do your fingers tremble when you hold them straight out?
5. _______ Is your hair dry & brittle or thin?
6. _______ Does your heart beat very fast after exerting yourself?
7. _______ Do you gain weight easily?
8. _______ Are you uncomfortable when it is very hot?

Total For Part #15: _________

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