Diet Questionnaire » Metabolism Classification Questionnaire

Metabolism Classification Questionnaire

The results of this questionnaire are tabulated and sent to P.I. Health Services, but we do not see your actual responses, so please be completely frank when filling out the questionnaire. This will ensure the best results for you. After you have submitted the completed questionnaire, a diet will be mailed to you within five business days.

There are 78 questions. Please try to answer all of them. Do the questions in any order; a screen at a time avoids excessive scrolling.

	Section A		Section B
	1. Anger Tendency to anger Almost never get angry Occasionally get angry		9. Cracking of Skin Frequent, severe skin cracking Occasional cracking of skin Almost never have cracking of skin
	2. Anxiety Tendency to experience anxiety Occasionally experience anxiety Rarely, if ever, anxious		10. Cravings Crave sardines, salmon, tuna, pickles or sour items Crave fruits or sweets Little or no craving
	3. Appetite Above normal or excessive Normal Diminished or lacking		11. Depression Frequently sad, morbid, dejected or withdrawn Have normal ups and downs Seldom have sad or rejected feeling
	4. Blushing Tend to blush easily Blush once in a while Difficult to make me blush		12. Digestion Usually have no trouble digesting any food Some foods bother me Many foods are difficult to digest
	5. Body weight Easy to gain weight Maintain my same weight Easy to lose weight		13. Dream Recall Recall my dreams frequently Almost no dream recall Sometimes remember dream
	6. Cold sores Have cold sores often Have cold sores occasionally Rarely, if ever, have cold sores		14. Dry Hair Tendency to dry hair Normal hair Oily, or slightly oily, hair
	7. Concentration Difficult to concentrate Normal concentration Good ability to concentrate		15. Dry Skin Tendency to dry skin Normal skin Tendency to oily skin
	8. Constipation Hard stools, often constipated Firm, normal stools Soft, running stools		16. Eating a vegetable meal makes me feel: Well satisfied Better if it is cooked Like I had practically nothing to eat

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	Section C		Section D
	17. Eating before bedtime Almost always makes me feel better Does not affect me Makes me toss, turn and sleep restlessly		29. Frequency of urination Tendency to urinate often Normal urination frequency Tendency to urinate infrequently
	18. Eating fruit makes me feel Very good and satisfied Almost satisfied Like I have had nothing to eat, or jittery		30. Frequent stools Have one or more bowel movements each day Have a bowel movement daily or every other day Have a bowel movement every 2 or 3 days
	19. Eating a meal containing meat makes me feel Very good and satisfied Usually better Very bad and sluggish		31. Hay fever Tendency to have hay fever Seldom have hay fever Never have hay fever
	20. Edema (Swelling) Sometimes have puffiness Hardly ever Frequently		32. Headaches Eyestrain cause headaches Occasionally have eyestrain headaches Seldom have eyestrain headaches
	21. Energy reserve High energy reserve Stable but occasionally run out of energy Low energy reserve		33. Hiccups Frequently have hiccups Occasionally have hiccups Never or almost never have hiccups
	22. Exercise Frequently enjoy it Sometimes enjoy it Dislike exercise very much		34. Hoarseness Often have hoarseness Seldom have hoarseness Never have hoarseness
	23. Eyebrows Very thick Normal growth Thin		35. Hypermotility of intestines Usually have rumbling or growling Occasionally have rumbling or growling Almost never have rumbling or growling
	24. Eyelids Eye lids open very wide/white shows above and below pupil Eyelids look saggy or droopy Eyelids have normal opening		36. Hypoglycemia (low blood sugar) Tendency to hypoglycemia No known hypoglycemia Tendency to diabetes
	25. Falling asleep Fall asleep quickly, most of the time Fall asleep within half hour Have some difficulty falling asleep		37. I desire between meal snacks like fruit, cake or candy bar Very often Sometimes Almost never
	26. Fatigue Often feel fatigued Occasionally fatigued Seldom fatigued		38. I desire between meal snacks like peanuts, cheese, potato chips A  lot Sometimes Almost never
	27. Fear Occasionally have fear Almost never have fear Often have fear		39. I like coffee Often Occasionally Rarely or never
	28. Fingernails Some cross ridges Smooth, normal fingernails Longitudinal ridges		40. I like fatty meats A lot Sometimes Very little, if at all
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	Section E		Section F
	41. I like potatoes Very much Occasionally Very little		53. Muscle tone and sculpturing Tending to have marked physique of opposite sex Physique normal to your sex Strong, well-defined physique of your sex
	42. I like raw salad and vegetables A lot Sometimes Very little		54. Nasal drainage Often have nasal drainage Seldom have nasal drainage Rarely have nasal drainage
	43. I like sauerkraut Often Sometimes Very little		55. Neurotic Frequently do things on impulse Once in a great while do things on impulse Seldom do things on impulse
	44. I like water A lot Very little Almost never		56. Neurosis Frequently have sense of ill health Occasionally have sense of ill health Frequently have sense of well-being
	45. I feel too warm Frequently Very rarely Never		57. Night person I come alive late afternoon or early evening I gradually slow down by late evening I'm an early to bed person
	46. Indigestion (Heartburn) Frequently have indigestion Occasionally have indigestion Never have indigestion		58. No matter what I eat It's difficult to gain weight My weight stays the same It's easy to gain weight
	47. Infectious Disease Very susceptible to infection Occasionally have infections Almost never have infections		59. Pain sensitivity Very sensitive to pain Normal pain sensitivity Tendency to pain insensitivity
	48. Insomnia Frequently have insomnia Occasionally have insomnia No insomnia - can fall asleep anytime		60. Rash and hives Often have rash and hives Occasionally have rash and hives Seldom have rash and hives
	49. Irritable Usually impatient Frequently impatient Seldom impatient		61. Reaction to strong light Very irritating Bothersome Very little irritation
	50. Itching Tendency to itching skin Only occasionally have itching skin Almost never have itching skin		62. Response to unexpected noise Marked reaction Normal reaction Sluggish reaction
	51. Moisture Content of Skin Tendency to have cold, clammy hands and feet Occasionally have cold, clammy hands and feet Tendency to have warm, dry skin		63. Seasickness or car sickness Tendency to motion sickness Occasionally have motion sickness Never or very rarely have motion sickness
	52. Morning Alertness I don't function well until about noon I get started without too much trouble I enjoy getting up early		64. Sensitive to shots, vaccinations and injections Usually have a severe reaction Occasionally have a reaction Rarely have a reaction
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