Download forms
GENERAL FORMS
- Consent and acknowledgment
- Food diary (5 page)
- Food frequency Questionnaire about your eating pattern
- Food preferences
- Registration
- HSR brochure
- HSR nutrition brochure
SPECIALTY FORMS FOR SELF USE
- ADHD questionnaire (basic)
- ADHD questionnaire (extended)
- Allergy questionnaire
- Autism questionnaire (basic)
- Autism questionnaire (extended)
- Cholesterol questionnaire
- Complex questionnaire
- Food allergy questionnaire (1 page)
- GI questionnaire
- Gluten sensitivity questionnaire
- Heart questionnaire
- Health savings account reimbursement form – Many Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) allow individuals to pay for nutrients, natural supplements, supplies, and other services with pre-tax dollars. These accounts may save you 20% to 30% of the costs of these items. Usually if the invoice is submitted on our statement/receipt this is sufficient. If you purchase elsewhere, most plans require a signed form from the healthcare provider outlining your need for it, and stating that the supplement recommended may be useful in improving your health.
- High blood pressure questionnaire
- Lung questionnaire
- Men’s health questionnaire
- Mood questionnaire
- Sleep history questionnaire
- Stress level questionnaire
- Supplement and medication worksheet
- Thyroid-adrenal axis questionnaire (2 page)
- Toxicity questionnaire (basic)
- Toxicity questionnaire (extended)
- Women’s health questionnaire
- Yeast questionnaire
DIRECTIONS, ILLUSTRATIONS AND SUMMARY SHEETS
- Axillary temperature (home thyroid assessment)
- Axillary temperature (for conception) (courtesy of Dr Chris Axelrad)
- Blood spot specimen collection instructions
- Diet contract
- GI Fx (CDSA) specimen collection instructions
- GUNA: Cytokines and inflammation
- GUNA: Introduction to the Method
- How to collect saliva for hormone testing (ZRT video)
- How to collect saliva for hormone testing (ZRT) pdf
- Iodine patch test (home assessment)
- MediClear Program Guide
- Organix urine specimen collection instructions
- Portion sizes
- Purification and detoxification instructions
- Purification guide-Standard Process
- Urine and saliva pH chart
- Weight loss goals
- Zinc adequacy questionnaire
