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Environmental poisoning can put your health in jeopardy. Thorne Research offer a range of products designed to help rid your body of these toxins.

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Here is a great way to assess your health needs. We provide health questionnaires to help you identify problem areas within your health.

Health Questionnaires

Candida | Gluten Sensitivity | Food Allergies | Hypoglycemia

(All information is held in strict confidentiality and will not be shared or sold)

FOOD ALLERGY QUESTIONNAIRE

Welcome to the world of delayed food allergies. Do you have or have you ever been told that you have any of the following symptoms? Please check "Symptom Occurs" if you experience this symptom, and check "Strong Symptom Occurance" for those that you experience often or quite strongly.

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Musculoskeletal	No Symptoms	Symptom Occurs Occasionally	Strong Symptom Occurrence
1. Rheumatoid Arthritis
2. Osteoarthrosis, generalized
3. Degenerative Joint Disease
4. Arthritis, allergic
5. Arthritis, allergic involving shoulder
6. Arthritis, allergic involving lower leg
7. Muscle or bone pain, migratory
8. Tendonitis, migratory
9. Fibromyalgia
10. "Growing Pains"
11. Stiffness or limitation of movement
12. Rheumatoid factor negative
Ear, Nose & Throat	No Symptoms	Symptom Occurs Occasionally	Strong Symptom Occurrence
1. Chronic serous otitis media
2. Chronic tubotympanic catarrh
3. Mucoid Otitis media glue ear
4. Dysfunction of eustachian tube fluid in ear
5. Chronic Sinus
6. Frequently clear throat
7. Frequent sore throat
8. Sinus polyps
9. Nasal polyps
10. Sinus trouble
11. Allergic rhinitis, chronic stuffy nose
12. Canker sores in mouth
13. Bad breath, metallic taste in mouth
14. Hoarsness, intermittent
15. Dizziness
16. Allergy, unspecified
17. Thick post nasal drip
Gastrointestinal	No Symptoms	Symptom Occurs Occasionally	Strong Symptom Occurrence
1. Esophageal, gastroesophageal reflux
2. Gastritic; allergic, irritant
3. Vomiting
4. Colitis
5. Constipation
6. Irritable bowel syndrome
7. Diarrhea
8. Ulcerative Colitis
9. Heartburn
10. Bloating hyperacidity
11. Colic in infants
Cardiovascular	No Symptoms	Symptom Occurs Occasionally	Strong Symptom Occurrence
1. Rapid or irregular heart-beat
2. Prolapsed mitral valve syndrome in healthy people
3. Edema of extremities
4. High blood pressure especially in the young
Chest	No Symptoms	Symptom Occurs Occasionally	Strong Symptom Occurrence
1. Chronic cough
2. Tightness in chest
3. Asthma, intrinsic
4. Asthma, allergic unspecified
5. Bronchitis, chronic
Endocrine	No Symptoms	Symptom Occurs Occasionally	Strong Symptom Occurrence
1. Hypoglycemia, low blood sugar
2. Hyperglycemia, high blood sugar
3. Thyroid, low (cold feet)
4. Weight gain - no diet works
Genitourinary	No Symptoms	Symptom Occurs Occasionally	Strong Symptom Occurrence
1. Cystitis
2. Enuresis, bed wetting in children
3. Vaginal itching or discharge
4. Yeast infections, chronic
5. PMS, fluid retention, irritability, severe cramps
Dermatological	No Symptoms	Symptom Occurs Occasionally	Strong Symptom Occurrence
1. Eczema intrinsic atopic
2. Dermatitis, adult and teenage acne
3. Acne Rosacea, red nose
4. Due to foods taken internally
5. Psoriasis
6. Rash or hives urticaria
7. Urticaria dry or itchy skin
Neuralgic	No Symptoms	Symptom Occurs Occasionally	Strong Symptom Occurrence
1. Migraine headaches - common
2. Cluster headaches
3. Tension or Sinus headaches
4. Headaches
5. Depression
6. Chronic fatigue or sluggishness
7. Anxiety or irritability
8. ADD w/Hyperactivity - restlessness
9. Learning disability - ADD
10. Behavior problems in children
11. Quick temper or impatient
12. Poor memory or comprehension
13. Mental confusion - Inability to focus
14. Short attention span

By checking this box, I am giving permission for the results of this questionnaire to be sent to Dr. Patricia Bender and to be contacted by her to discuss them

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