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“The-Whole-List-ic” Quiz
Is Functional Medicine right for me?
The "Whole List ic"Quiz
Please select all that apply
Are you being told everything looks "normal" but don't feel well?
Are you confused with all the conflicting information online?
Is your current state of health preventing you from doing the things you enjoy?
Are you seeking the ROOT CAUSES?
Are you looking for a more comprehensive approach?
Are you looking for accountability?
Are you looking for a team that is empathetic and supportive?
Are you willing to take responsibility over your health?
Energy Production - Pillar 1/6
Please select all that apply
Do you want more energy?
Do you feel tired when reading a book?
Do you feel tired when driving for longer distances?
Do you feel tired after a short duration of activity?
Are you tired when you wake up in the morning?
Do you need stimulants to wake you up or keep going?
Is your energy inconsistent throughout the day?
Do you take longer than before to recover from exercise or illness?
Detoxification - Pillar 2/6
Please select all that apply
Are you sensitive to chemicals like perfumes, exhaust fumes, or cleaning products?
Do you have a history of medication use?
Do you have high liver enzymes?
Do you lose weight and quickly gain it back?
Have you been exposed to industrial chemicals at work?
Do you eat a diet that is NOT organic or eat processed and packaged foods?
Have you recently bought a new home, car, furniture, or carpeting?
Do you spend a lot of time indoors?
Is there any yellowing of your eyes?
Do you have elevated triglycerides?
Brain Health - Pillar 3/6
Please select all that apply
Are you noticing a decline in your memory (short or long term)?
Do you walk into a room and forget why?
Are your math skills declining?
Do you have a hard time with directions?
Are you having a hard time learning new tasks?
Do you dream at night but forget your dreams?
Do you have a history of high or low blood sugars?
Do you ever feel depressed or anxious?
Do you have a hard time focusing?
Have others noticed a change in your mood or behavior?
Do you have a hard time starting and finishing tasks?
Diet and Digestion - Pillar 4/6
Please select all that apply
Do you experience bloating?
Do you have less then 7 bowel movements per week?
Do your bowel movements feel incomplete?
Do you have any history of food poisoning?
Have you ever gotten sick while traveling?
Have taken more than 3 rounds of antibiotics in your lifetime?
Do you feel like your food is not being digested?
Do you suspect any food intolerance?
Do you have any skin issues (eczema, psoriasis, acne)?
Do you experience any joint aches and pains associated with your diet?
Do you ever have blood or mucous in your stool?
Do you have heartburn?
Are you on any medications for digestive function?
Have you had a "normal" GI scope but still have functional issues?
Do you experience any stomach cramps or pain?
Have you been diagnosed with IBS?
Stress, Hormones and Inflammation - Pillar 5/6
Please select all that apply
Do you feel like stress is affecting your life?
Do you feel tired in the morning after enough sleep?
Do you wake up between 2-4 AM in the morning?
Do you feel tired between 2-4 PM and need caffeine to keep going?
Have you suffered any major losses recently or in the past that have not been addressed?
Do you have emotional instability?
Do you feel exhausted shortly after you exercise?
Do you crave sugar, salts, and fats?
Do you feel like your sleep is broken?
Do you carry weight in the mid-section that is hard to lose?
Do you feel like you don't have time for yourself?
Do you feel anxious?
Has your motivation not what it used to be?
Do you experience hot flashes?
Do you have PMS?
Do you experience mood swings?
Has your libido (sex drive) dropped?
Do you experience aches and pains that don't seem to go away?
Lifestyle and Environment - Pillar 6/6
Please select all that apply
Do you experience a lot of stress at work?
Have you ever been abused (physically or emotionally)?
Do you have a supportive network of friends and family?
Has your home been water damaged?
Do you spend less than 4 hours in nature per week?
Is your job sedentary?
Do you spend more than 4 hours in front of a computer per day?
Do you go to bed after 10 PM?
Do you carry your cell phone with you at all times?
Do you have a hard time practicing meditation, deep breathing, or other relaxation techniques?
Do you have a hard time sticking to an exercise/activity program?
Name
*
First
Last
Date of birth
*
Date Format: MM slash DD slash YYYY
The email you check most often
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Enter Email
Confirm Email
Please list your top 3 health goals
Example: more energy, better digestion, put my autoimmune condition into remission
What is the best phone number to reach you?
*
Example: (614) 656-6455
How did you hear about us?
*
example: friend referral, health professional, Facebook, google search
