DRAINAGE AND DETOXIFICATION QUESTIONNAIRE

Note: "You will be receiving result of your detoxification and drainage within the next 48 hours. Assessment will be done by the Health professionals. Final recommended cleansing procedure will be sent also through your email."

The Importance of Cleansing Body Detoxification

Your body is constantly working to eliminate toxins through your lungs, kidneys, digestive system and especially your liver. Every minute of every day, your properly functioning liver eliminates small amounts of toxins, heavy metals, bacteria and other impurities from your blood before returning it into circulation.

Perhaps in an ideal world - a world without environmental challenges, stress, pesticides and processed foods - cleansing wouldn't be necessary. But that simply isn't the case for most of us in the 21st century. This is why regular cleansing of the body, and especially the liver and colon, is vital to maintaining your good health, be it preventing disease, or just to ensure that your body is operating the way it was meant to.

Benefits of Cleansing  Benefits of cleansing include: 

• Improved health
• Improved digestive health
• Improvements in energy levels
• Healthier skin
• Healthier hair and nails
• Improved cognitive function
• Improved sleep
• Less stress, greater relaxation, calmer stomach

YOU WANT TO KNOW THE RIGHT CLEANSING PROCESS FOR YOU? 

FILL-IN THE FORM AND SUBMIT. 

OUR HEALTH PROFESSIONALS  WILL TAKE CARE OF  YOUR CONCERNS!

THANK YOU...

Name:
Email Address:
Contact #:
Address:
Age:
Sex:	Male Female
Civil Status:	Single Married Separated/ Divorced Widow Open Relationship
Occupation:
Health Concerns:	High Blood/ Hypertension Arthritis Diabetes Kidney Dysfunction Weight Loss Skin Allergies/ Problems Others
Other Health Concerns:
Kindly enumerate any pharmaceutical medicine you are currently using/maintenance:
Kindly rate the following conditions based on the following rating scale: 1-Never 2-Occasionally have it 3-Occasionally have it, effect is severe 4-Frequently have it, effect is not severe 5-Frequently have it, effect is severe
Irritability (Pagkamagagalitin):	1 2 3 4 5
Nervousness (Nerbiyos):	1 2 3 4 5
Mood Swings (Moody):	1 2 3 4 5
Frequently crying (Iyakin):	1 2 3 4 5
Aggressive behavior:	1 2 3 4 5
Anxiety (Pagkabalisa):	1 2 3 4 5
Fear (Takot):	1 2 3 4 5
Confusion (Pagkalito):	1 2 3 4 5
Depression:	1 2 3 4 5
Suicidal thoughts:	1 2 3 4 5
Increased sweating, ear wax, oily skin:	1 2 3 4 5
Rashes (Pantal):	1 2 3 4 5
Brown spots on hands and face:	1 2 3 4 5
Boils (Pigsa):	1 2 3 4 5
Skin tags (Peklat):	1 2 3 4 5
Acne:	1 2 3 4 5
Eczema:	1 2 3 4 5
Fever blisters:	1 2 3 4 5
Fever blisters:	1 2 3 4 5
Increased Salivation (Paglalaway):	1 2 3 4 5
Mouth Ulcers (singaw):	1 2 3 4 5
Common Colds:	1 2 3 4 5
Sinusitis:	1 2 3 4 5
Sore throats (Pangangati ng kalamnan):	1 2 3 4 5
Ear Infection:	1 2 3 4 5
Hay Fever (allergies):	1 2 3 4 5
Loss of Smell:	1 2 3 4 5
Cough (Ubo):	1 2 3 4 5
Hyperactivity:	1 2 3 4 5
Stammering or Word finding problems:	1 2 3 4
Difficulty on concentration:	1 2 3 4 5
Sleep disturbance:	1 2 3 4 5
Difficulty in making decisions:	1 2 3 4 5
Headache:	1 2 3 4 5
Poor memory:	1 2 3 4 5
Poor coordination:	1 2 3 4 5
Compulsive behavior:	1 2 3 4 5
Severe sleep disturbance:	1 2 3 4 5
Memory loss:	1 2 3 4 5