Online Nutrition & Health Evaluation

 

 

         

 

 


 

Free Nutrition & Health Evaluation with Purchase,
or Reasonably Priced if you have your own source.

Please read the following carefully for complete details.


You will be completing a form at my other website, plus the form below. Here are step-by-step instructions, please read everything carefully, it's easy! 

1) Bookmark this page so that you do not lose it during the process of completing forms.  All are set to open separate web pages, but just in case.

2) Click here and complete the form by checking the appropriate boxes.  When you have completed the form, and clicked through to see the results, you will get a page that looks like the following, my results from early June 2008:


3)  Go to the form below, and in the first box, type each body "system" and your "rating" for each from your results.

(Note: You may view the remedies that are suggested for each body system by clicking your mouse on the "system" name on your results which will look like what you see above. If it has a "fair" or "poor" rating, you may wish to purchase the items indicated - the results are quite accurate, or you may prefer waiting until we have completed your entire evaluation, please read on.)

4)  Complete the rest of the form below, and when you think your questions are complete, please click "submit", review your answers, and "send" to me.  DO NOT use "back" or "forward" buttons on your browser while completing the form, or there is a chance you will lose the answers you have filled in.

(Note: If you would prefer, I can email the questions on the form in (a) "Word" format, or (b) within an email.  This way you can answer the questions without concern about losing internet connection, and can answer the questions at your leisure.  With method (a) you can return the completed and "saved" form to me attached to an email;  in method (b) by "replying" to the email, and putting your answer after each of the questions.  To do this, complete the first part of the form with your name, email, etc., and the first 2 boxes following the instructions above each, and "submit".  You can leave all other boxes blank.)

5) Payment Information: If your have ever purchased $40 in herbal remedies or other supplements from my website, or will be when we complete your profile,  you qualify for a free Nutrition and Health Evaluation.

If you have a source for herbal remedies and supplements, and will not be purchasing through me, your Nutrition and Health Evaluation will cost $35.  Please pay by credit card or through your PayPal account using the "Pay Now" button below. You do not have to be a PayPal member to make a payment using this method.

(Note: There is a money-back guarantee within 30 days of your payment date if you are not satisfied.  If you pay with a credit card, your refund will be credited to your credit card account.  After making your payment, you will be re-directed to a page with a link back to this form, but just in case, you may want to bookmark this page. You are welcome to complete the forms using the methods discussed before making your qualifying purchase or payment, but I will await your payment before sending your results.)

6)  When I have finished reviewing your evaluation, I will prepare a booklet for you with your results in Word and PDF formats, and send to you by email.  We will talk by phone or communicate by email after you have reviewed your results.

I look forward to helping you in your journey to health.


   

 

Name:

Email:

Phone:

State or Time Zone:

Height:

Weight:

Birthdate:

Enter results from # 2,3 above - List "System" and "Rating" for each:


Would you rather receive the following questions on this form in email
or Word format?  In the following box, let me know your preference, and ask
any questions you may have, then go to the bottom of this page and "submit". 

Otherwise, skip this box, and complete the form and "submit".

BREAKFAST - List what you typically eat and drink:

                  Mid-Morning - List what you typically eat/drink:                      

Lunch - List what you tyically eat/drink:

Mid-Afternoon - List what you typically eat/drink:

 

DINNER - List what you typically eat/drink:

BEDTIME - If you have a bedtime-snack, list here:

SUPPLEMENTS - List any vitamins, herbs, etc. here

MEDICATIONS - List any medications you are taking:

Do you Smoke and/or Drink Alcohol, if so, what & how often?

ANTIBIOTICS - How often have you needed them in the past year?

Common or Chronic Ailments:

  Any health issue you are dealing with now, or deal with on a regular basis.

Women, Do you take birth control pills?

 

Women, are you pre- or post-menopausal?

Do you Exercise, if so how, and how often?

Any Additional Information, Questions, Comments:

 

   

 

 
Nutritional & Health Evaluation prepared and provided by Claudia L. Meydrech, CN

Thank you for your interest in my Nutrition & Health Evaluation. I have been helping people find health through nutrition for over 22 years.  After attending college, and a few years learning and teaching others about medicinal herbs, I continued my education and received my CN designation (Certified Nutritionist).  This was through a 2+ year course of study offered by American Health Sciences University in Colorado, which closed in January of 2008 as explained in this document.  I have recently been informed that AHSU is still offering continuing education courses.  My course of study was a balance of both traditional and alternative approaches to improving health, my strength and love being the alternative approach. I have also learned through working with those knowledgeable in the use of medicinal herbs and supplements, and by attending seminars and continuing education courses.
 
Disclaimer:  I am not a doctor, and do not prescribe or diagnose.  You are responsible for what you do with the information you will find on this site, and for the outcome.


Copyright 1999-2009 Claudia L. Meydrech, CN

Updated 4/19/09