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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
9. Cracking of Skin
2. Anxiety
10. Cravings
3. Appetite
11. Depression
4. Blushing
12. Digestion
5. Body weight
13. Dream Recall
6. Cold sores
14. Dry Hair
7. Concentration
15. Dry Skin
8. Constipation
16. Eating a vegetable meal makes me feel:
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Section C Section D
17. Eating before bedtime
29. Frequency of urination
 
18. Eating fruit makes me feel
30. Frequent stools
19. Eating a meal containing meat makes me feel
31. Hay fever
20. Edema (Swelling)
32. Headaches
21. Energy reserve
33. Hiccups
22. Exercise
34. Hoarseness
23. Eyebrows
35. Hypermotility of intestines
24. Eyelids
36. Hypoglycemia (low blood sugar)
25. Falling asleep
37. I desire between meal snacks like fruit, cake or candy bar
26. Fatigue
38. I desire between meal snacks like peanuts, cheese, potato chips
27. Fear
39. I like coffee
28. Fingernails
40. I like fatty meats
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Section E Section F
41. I like potatoes
53. Muscle tone and sculpturing
42. I like raw salad and vegetables
54. Nasal drainage
43. I like sauerkraut
55. Neurotic
44. I like water
56. Neurosis
45. I feel too warm
57. Night person
46. Indigestion (Heartburn)
58. No matter what I eat
47. Infectious Disease
59. Pain sensitivity
48. Insomnia
60. Rash and hives
49. Irritable
61. Reaction to strong light
50. Itching
62. Response to unexpected noise
51. Moisture Content of Skin
63. Seasickness or car sickness
52. Morning Alertness
64. Sensitive to shots, vaccinations and injections
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Section G
65. Sensitive to stings and insect bites
66. Sex drive
67. Skin thickness
68. Sleeping patterns
69. Sour stomach (food feels like rock or lump)
70. Stress tolerance
71. Sweating
72. Temperature (when sick)
73. Urine (ability to hold urine)
74. Voice change
75. Waking up in night
76. Whatever I eat turns to fat
Section H
77. Wheezing
78. Worry
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Now you are finished! Please enter your contact information below.
Name:
Address: 
Phone:
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as well as your contact information!

 


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