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Find out WHY you might have health problems by taking this test.

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This is a test of common symptoms which can give an indication of possible causes of health conditions. Developed over many years of research, the survey classifies over 220 symptoms by likely physiological cause. For those people with health issues who are interested in what is actually causing their problems, this can be a very valuable tool.

In our experience, the biggest barrier to a higher quality of life is a lack of knowledge or information regarding the cause of health problems and what could be done about them.

This is an opportunity to get this information for yourself.

Follow the instructions and take the test. In some cases the grouping of marked symptoms will give immediate feedback on the area of most stress.

Submit your completed test to the Center for a computer analysis and phone consultation* with a doctor or case manager regarding the cause of your health problems as indicated by this test. They will also be able to give you information on various solutions to the types of issues you may have.

All information from this test is considered private medical information and is protected under law from unauthorized disclosure. We are prohibited by law from releasing your name, address or phone to any other organization or person. This test is hosted from a secure server which is the same level of protection used to make secure financial transactions on the web.

INSTRUCTIONS

Check the box that applies to you. Check either:

  1. MILD (problem occurs rarely)
  2. MODERATE (problem occurs several times per month)
  3. SEVERE (problem is constant or almost constant)

If you do not experience a symptom, leave it blank by not checking any boxes.

Sympathetic Dominance

Relates to a "stuck gas pedal" in the nervous system. Read More.

1 = Mild, 2 = Moderate, 3 = Severe
1. 1 2 3 Acid foods upset
2. 1 2 3 Get chilled often
3. 1 2 3 "Lump" in throat
4. 1 2 3 Dry mouth, eyes and nose
5. 1 2 3 Pulse speeds after meal
6. 1 2 3 Keyed up - fail to calm
7. 1 2 3 Cuts heal slowly
8. 1 2 3 Gag Easily
9. 1 2 3 Unable to relax; startles easily
10. 1 2 3 Extremities cold and clammy
11. 1 2 3 Strong light irritates
12. 1 2 3 Urine amount reduced
13. 1 2 3 Heart pounds after retiring
14. 1 2 3 "Nervous" stomach
15. 1 2 3 Appetite reduced
16. 1 2 3 Cold sweats often
17. 1 2 3 Fever easily raised
18. 1 2 3 Neuralgia - like pains
19. 1 2 3 Staring, blinks little
20. 1 2 3 Sour stomach often

Parasympathetic Dominance

Relates to a "stuck break pedal" in the nervous system. Read More.

1 = Mild, 2 = Moderate, 3 = Severe
21. 1 2 3 Joint stiffness on arising
22. 1 2 3 Muscle, leg, or toe cramps at night
23. 1 2 3 "Butterfly" stomach cramps
24. 1 2 3 Eyes or nose watery
25. 1 2 3 Eyes blink often
26. 1 2 3 Eyelids swollen and puffy
27. 1 2 3 Indigestion soon after meals
28. 1 2 3 Always seems hungry; feels light headed often
29. 1 2 3 Digestion rapid
30. 1 2 3 Vomiting frequent
31. 1 2 3 Hoarseness frequent
32. 1 2 3 Breathing irregular
33. 1 2 3 Pulse slow; feels "irregular"
34. 1 2 3 Gagging reflex slow
35. 1 2 3 Difficulty swallowing
36. 1 2 3 Constipation, diarrhea alternating
37. 1 2 3 "Slow starter"
38. 1 2 3 Get "chilled" frequently
39. 1 2 3 Perspire easily
40. 1 2 3 Circulation poor, sensitive to cold
41. 1 2 3 Frequent colds, asthma, bronchitis

Sugar Handling

Processing and managing carbohydrates eaten in the diet. Read More.

1 = Mild, 2 = Moderate, 3 = Severe
42. 1 2 3 Eat when nervous
43. 1 2 3 Excessive appetite
44. 1 2 3 Hungry between meals
45. 1 2 3 Irritable before meals
46. 1 2 3 Get "shaky" if hungry
47. 1 2 3 Fatigue, eating relieves
48. 1 2 3 "Lightheaded" if meals delayed
49. 1 2 3 Heart palpitates if meals missed
50. 1 2 3 Afternoon headaches
51. 1 2 3 Overeating sweets upsets
52. 1 2 3 Awaken after few hours sleep, hard to get back to sleep
53. 1 2 3 Afternoon craving of candy, coffee
54. 1 2 3 Moods of depression - "blues"
55. 1 2 3 Cravings for sweets or snacks

Cardiovascular

Function of heart and circulatory systems. Read More.

1 = Mild, 2 = Moderate, 3 = Severe
56. 1 2 3 Hands and feet go to sleep easily
57. 1 2 3 Sigh frequently, "air" hunger
58. 1 2 3 Aware of "breathing heavily"
59. 1 2 3 High altitude discomfort
60. 1 2 3 Opens windows in closed rooms
61. 1 2 3 Susceptible to colds and fevers
62. 1 2 3 Afternoon "yawner"
63. 1 2 3 Get "drowsy" often
64. 1 2 3 Swollen ankles, worse at night
65. 1 2 3 Muscle cramps, worse during exercise; get "charley horses"
66. 1 2 3 Shortness of breath on exertion
67. 1 2 3 Dull pain in chest or radiating into left arm, worse on exertion
68. 1 2 3 Bruise easily, "black and blue" spots
69. 1 2 3 Tendency to anemia
70. 1 2 3 "Nose bleeds" frequent
71. 1 2 3 Noises in head, or "ringing in ears"
72. 1 2 3 Tension under the breastbone, or feeling of "tightness", worse on exertion

Liver & Gallbladder

Detoxification and fat metabolism. Read More.

1 = Mild, 2 = Moderate, 3 = Severe
73. 1 2 3 Dizziness
74. 1 2 3 Dry skin
75. 1 2 3 Burning feet
76. 1 2 3 Blurred vision
77. 1 2 3 Itching skin and feet
78. 1 2 3 Excessive falling hair
79. 1 2 3 Frequent skin rashes
80. 1 2 3 Bitter, metallic taste in mouth in mornings
81. 1 2 3 Bowel movements painful or hard
82. 1 2 3 Worrier, feels insecure
83. 1 2 3 Feeling queasy, headache over eyes
84. 1 2 3 Greasy foods upset
85. 1 2 3 Stool light colored
86. 1 2 3 Skin peels on foot soles
87. 1 2 3 Pain between shoulder blades
88. 1 2 3 Use laxatives
89. 1 2 3 Stools alternate from soft to watery
90. 1 2 3 History of gallbladder attacks or gallstones
91. 1 2 3 Sneezing attacks
92. 1 2 3 Nightmare type bad dreams
93. 1 2 3 Bad breath (halitosis)
94. 1 2 3 Milk products cause distress
95. 1 2 3 Sensitve to hot weather
96. 1 2 3 Burning or itching anus
97. 1 2 3 Crave sweets

Digestion

Ability to metabolize proteins. Read More.

1 = Mild, 2 = Moderate, 3 = Severe
98. 1 2 3 Loss of taste for meat
99. 1 2 3 Lower bowel gas several hours after eating
100. 1 2 3 Burning stomach sensations, eating relieves
101. 1 2 3 Coated tongue
102. 1 2 3 Pass large amounts of foul-smelling gas
103. 1 2 3 Indigestion 1/2 - 1 hour after eating; may be up to 3-4 hours
104. 1 2 3 Mucous colitis or "irritable bowel"
105. 1 2 3 Gas shortly after eating
106. 1 2 3 Stomach "bloating" after eating

Endocrine (Hormone) System

Hormones are a major communication system, crucial for maintaining all major body systems.
Thyroid: Controls speed of metoabolism, passage of nutrients into cells and waste out of cells.
Pituitary: Controls digestion and reproduction systems.
Adrenals: Controls energy, emergency response, fluid balance.

Hyperthyroid - "Overspeeding" Thyroid. Read More.

1 = Mild, 2 = Moderate, 3 = Severe
107. 1 2 3 Insomnia
108. 1 2 3 Nervousness
109. 1 2 3 Can't gain weight
110. 1 2 3 Intolerance to heat
111. 1 2 3 Highly emotional
112. 1 2 3 Flush easily
113. 1 2 3 Nights sweats
114. 1 2 3 Thin, moist skin
115. 1 2 3 Inward trembling
116. 1 2 3 Heart palpitates
117. 1 2 3 Increased appetite without weight gain
118. 1 2 3 Pulse fast at rest
119. 1 2 3 Eyelids and face twitch
120. 1 2 3 Irritable and restless
121. 1 2 3 Can't work under pressure

Hypothyroid "Sluggish" Thyroid

Read more.

1 = Mild, 2 = Moderate, 3 = Severe
122. 1 2 3 Increase in weight
123. 1 2 3 Decrease in appetite
124. 1 2 3 Fatigue easily
125. 1 2 3 Ringing in ears
126. 1 2 3 Sleepy during day
127. 1 2 3 Sensitive to cold
128. 1 2 3 Dry or scaly skin
129. 1 2 3 Constipation
130. 1 2 3 Mental sluggishness
131. 1 2 3 Hair coarse, falls out
132. 1 2 3 Headaches upon arising, wear off during day
133. 1 2 3 Slow pulse, below 65
134. 1 2 3 Frequency of urination
135. 1 2 3 Impaired hearing
136. 1 2 3 Reduced initiative

Hyperpituitary "Overspeeding" Pituitary

Read more.

1 = Mild, 2 = Moderate, 3 = Severe
137. 1 2 3 Failing memory
138. 1 2 3 Low blood pressure
139. 1 2 3 Increased sex drive
140. 1 2 3 Headaches, "splitting or rending"
141. 1 2 3 Decreased sugar tolerance

Hyporpituitary "Sluggish" Pituitary

Read more.

1 = Mild, 2 = Moderate, 3 = Severe
142. 1 2 3 Abnormal thirst
143. 1 2 3 Bloating of abdomen
144. 1 2 3 Weight gain around hips or waste
145. 1 2 3 Sex drive reduced or lacking
146. 1 2 3 Tendency to ulcers, colitis
147. 1 2 3 Increased sugar tolerance
148. 1 2 3 Women: menstrual disorders
149. 1 2 3 Young girls: lack of menstrual function

Hyperadrenal "Overspeeding" Adrenals

Read more.

1 = Mild, 2 = Moderate, 3 = Severe
150. 1 2 3 Dizziness
151. 1 2 3 Headaches
152. 1 2 3 Hot flashes
153. 1 2 3 Increased blood pressure
154. 1 2 3 Hair growth on face or body (female)
155. 1 2 3 Sugar in urine (not diabetes)
156. 1 2 3 Masculine tendencies (female)

Hypoadrenal "Sluggish" Adrenals

Read more.

1 = Mild, 2 = Moderate, 3 = Severe
157. 1 2 3 Weakness, dizziness
158. 1 2 3 Chronic fatique
159. 1 2 3 Low blood pressure
160. 1 2 3 Nails weak, rigid
161. 1 2 3 Tendency to hives
162. 1 2 3 Arthritic tendencies
163. 1 2 3 Perspiration increase
164. 1 2 3 Bowel disorders
165. 1 2 3 Poor circulation
166. 1 2 3 Swollen ankles
167. 1 2 3 Crave salt
168. 1 2 3 Brown spots or bronzing of skin
169. 1 2 3 Allergies - tendency to asthma
170. 1 2 3 Weakness after colds, influenza
171. 1 2 3 Exhaustion - muscular or nervous
172. 1 2 3 Respitory disorders

Foundational Issues

Vitamin B deficiencies affect nerve and muscle function including heart operation and brain neurochemistry, sugar metabolism and eye, skin, hair, hormones, spleen and much much more. Read More.

1 = Mild, 2 = Moderate, 3 = Severe
173. 1 2 3 Apprehension
174. 1 2 3 Irritability
175. 1 2 3 Morbid fears
176. 1 2 3 Never seems to get well
177. 1 2 3 Forgetfulness
178. 1 2 3 Indigestion
179. 1 2 3 Poor appetite
180. 1 2 3 Craving for sweets
181. 1 2 3 Muscular soreness
182. 1 2 3 Depression; feelings of dread
183. 1 2 3 Noise sensitivity
184. 1 2 3 Acoustic hallucinations
185. 1 2 3 Tendency to cry without reason
186. 1 2 3 Hair is coarse and / or thinning
187. 1 2 3 Weakness
188. 1 2 3 Fatigue
189. 1 2 3 Skin sensitive to touch
190. 1 2 3 Tendency toward hives
191. 1 2 3 Nervousness
192. 1 2 3 Headache
193. 1 2 3 Insomnia
194. 1 2 3 Anxiety
195. 1 2 3 Anorexia
196. 1 2 3 Inability to concentrate; confusion
197. 1 2 3 Frequent stuffy sinus, infections
198. 1 2 3 Allergy to some foods
199. 1 2 3 Loose joints

Female Hormone System

Read More.

1 = Mild, 2 = Moderate, 3 = Severe
200. 1 2 3 Very easily fatigued
201. 1 2 3 Premenstrual tension
202. 1 2 3 Painful menses
203. 1 2 3 Depressed feelings before period
204. 1 2 3 Periods excessive and prolonged
205. 1 2 3 Painful breasts
206. 1 2 3 Menstruate too frequently
207. 1 2 3 Vaginal discharge
208. 1 2 3 Hysterectomy/ ovaries removed (check #3)
209. 1 2 3 Menopausal hot flashes
210. 1 2 3 Menses scanty or missed
211. 1 2 3 Acne worse at menses
212. 1 2 3 Depression of long standing

Male Hormone System

Read More.

1 = Mild, 2 = Moderate, 3 = Severe
213. 1 2 3 Prostate trouble
214. 1 2 3 Unrination difficult or dribbling
215. 1 2 3 Night urination frequent
216. 1 2 3 Depression
217. 1 2 3 Pain on inside of legs or heels
218. 1 2 3 Feeling of incomplete bowel evacuation
219. 1 2 3 Lack of energy
220. 1 2 3 Migrating aches and pains
221. 1 2 3 Tire too easily
222. 1 2 3 Avoids activity
223. 1 2 3 Leg nervousness at night
224. 1 2 3 Diminished sex drive

Main Symptoms

Please list below the five main physical complaints you have
in order of their importance.
1.
2.
3.
4.
5.

NOTE: All submitted information is considered medical records and is protected under law from unauthorized disclosure. We are prohibited by law from releasing your name, address, or phone to any other organization or person. This test is hosted from a secure server to provide a high level of confidentiality of your answers and personal information.

NOTE: Your test will be reviewed and one of our associates will call you to discuss:

  • More information and explanation on the likely causes of your health problems based on this survey as well as additional information the doctor may get from you during the consultation.
  • Actions you could take yourself to help improve your health.
  • Recommendations for workshops and/ or services from the center that could help you regain your health.
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