Get Immunitrition Confidential Health Questionnaire Word With

Filling out the Immunitrition Confidential Health Questionnaire is an essential step towards gaining insights into your health and nutrition needs. This guide will provide you with clear and simple instructions to ensure your experience is smooth and efficient.

Follow the steps to complete your questionnaire effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the document editor.
2. Start by entering your personal information in the designated fields. This includes your name, email address, street address, city, state, zip code, home phone, and work/cell phone.
3. Provide your date and place of birth, age, gender, height, and current weight. If you wish for your weight to change, indicate your goals in the relevant field.
4. Complete your occupational details, answering how many hours you typically work each week and sharing your relationship status and information on any children.
5. If known, input your blood type and the name of the person who referred you to Immunitrition.
6. Describe the symptoms you are currently experiencing and what you hope to accomplish from the consultation.
7. Answer questions regarding your sleep patterns, including how well you sleep, wake-up times, and overall feelings upon waking.
8. Detail your consumption of caffeinated drinks, smoking habits, alcohol intake, and soda consumption.
9. Outline your exercise routine and how much water you drink daily.
10. List any supplements or medications you are currently taking, including brand names and dosages.
11. Note any known allergies to medications or herbs and indicate if you're under any practitioner’s care.
12. Provide information on any previous surgeries, injuries, or childhood diseases.
13. Reflect on your eating and drinking habits, including meals and snacks, and note your food preparation habits.
14. Indicate any food allergies or intolerances you may have.
15. Complete the hormonal testing and family health history sections as necessary.
16. For women, offer detailed information about menstrual history and any pregnancies.
17. Finish by answering the health checklist, marking ‘Y’ or ‘N’ for each symptom.
18. Finally, review all your answers for accuracy. Once completed, save your changes, download the document, and prepare to submit it as instructed.

Complete your Immunitrition Confidential Health Questionnaire online today for a healthier tomorrow.