Welcome to Optimal Health T.C. Health Clinic!

 This questionnaire asks you to assess how you've been feeling for the last four months. This information will help you track how your physical, mental, and emotional states respond to changes you make in your eating habits, priorities, supplement program, social and family life, level of physical activity, and time spent on personal growth. All information is held in strict confidence. Take all the time you need to complete this questionnaire. 

For each question, circle the number that best describes your symptoms:

• No or Rarely—You have never experienced the symptom, or the symptom is familiar to you, but you perceive it as insignificant (monthly or less). 
• Occasionally—Symptom comes and goes and is linked in your mind to stress, diet, fatigue, or some identifiable trigger. 
• Often — Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it 
• Yes or Frequently—Symptom occurs four or more times per week, and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis. 

Some questions require a YES or NO response: No= NO Frequently = YES.