Wellness profile


                    WELLNESS PROFILE
     
    NAME  ____________________________________        
      
    BIRTH-DATE  _____/_____/_____ TIME:  ___:___ AM / PM

    BLOOD TYPE:  A+___  A-___ B+___  B-___  AB+___  AB-___ O___

         SYMPTOMS OF HEALTH        4 = Excellent, 3 = Good, 2 = Fair, 1 = Poor
        
    Health of Hair and Scalp       _______         
    Health of Skin                       _______
    Health of Teeth and Gums    _______
    Eye Sight                              _______
    Hearing                                 _______
    Memory/Mind Function         _______
    Sense of Taste                     _______
    Sense of Smell                     _______
    Joints and Bones                  _______
    Spine and Skeletal System   _______
    Finger and Toe Nails            _______
    Muscle and Ligaments          _______
    Stomach/Digestion               _______
    Colon/Elimination                  _______
    Glands/Hormonal System      _______
    Spleen/Lymphatic System     _______
    Pancreas                              _______
    Liver/Gall Bladder                 _______
    Lungs                                   _______
    Kidneys                                 _______
    Bladder                                 _______
    Heart                                     _______
    Small Intestines                     _______
    Circulation/Vascular System  _______
    Perspiration                           _______
    Energy and Endurance Levels _______
    Nervous System                    _______
    Breathing/Respiratory           _______
    Breast                                   _______
    Female Reproductive System  _______
    Male Reproductive System    _______
    Sleep Patterns                       _______
                TOTAL                    _______

COMPARE YOUR TOTALS IN 21 DAYS, 90 DAYS, 6 MONTHS, 1 YEAR, 2 YEAR, ETC.
     
Please submit specific questions or request for a complete WELLNESS PROGRAM to:
                                                               
                                       [email protected]

Leave a Reply

Your email address will not be published. Required fields are marked *