HARRIS INTEGRATED HEALTH AND NUTRITION
Welcome
Meet Dr. Harris
Do You Feel Lucky
Our Philosophy
Professional Affiliations
Paperwork
Health History
Digestive and Lifestyle Symptoms Assessment
Digestive Health Appraisal Questionairre
Female Hormone Self Assessment
Male Hormone Self Assessment
Medical Symptoms Questionaire
Nutritional Assessment
Gluten Sensitivity Assessment
Dairy Sensitivity
Toxin Exposure Assessment
Toxic Burden
Clinical Clues of Low Stomach Acid
Leaky Gut/Intestinal Permeability
>
Candida Assessment
Causes of Leaky Gut Syndrome
Programs
Eye to Eye
>
All Inclusive
Life in the Middle
Pay as You Go
From a Distance
>
All Inclusive
Life in the Middle
Pay as You Go
Diet Lifestyle Environment
Diet
Lifestyle
Environment
Resources
Book; Our Modern Mortal Trilogy
Detox and Meal Replacement
Comprehensive Elimination Diet
Daily/Weekly Physical Activity
Food Diary
>
Daily/Weekly Food Diary
Recipe's
>
Snacks/Appetizers/Soups
Entrees
>
Breakfast
Lunch
Dinner
Salads/Desserts
All Things Coconut
Out of the Box NEK TV
Newsletters
FAQ
A List of Lists
Answers to QUARA
Blog
Power Point Presentations
Cancer
Cancer
Digestive Health Appraisal Questionairre
PLEASE FILL OUT FORM AS BEST YOU CAN AND SUBMIT IT BY CLICKING THE BUTTON BELOW
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Occupation
*
Phone Number
*
Height
*
Weight
*
Marital Status
*
Married
Single
Partner
Divorced
Widow(er)
Number of Children
*
Date
*
Email
*
Date of Birth
*
Gender
*
Male
Female
Section A; Oral and Dental Health
A sore in your mouth that doesn't heal
*
0
1
2
3
Canker sores or cold sores
*
0
1
2
3
Dry mouth/Poor salivation
*
0
1
2
3
Loose teeth or receding gums
*
0
1
2
3
Bleeding or swelling after you floss or brush your teerth
*
0
1
2
3
Chronic bad breath or sour taste in mouth
*
0
1
2
3
Fissures in your tongue or geographic tongue (red Patches)
*
0
1
2
3
Pain in tooth or mouth
*
0
1
2
3
Periodontal Disease
*
0
1
2
3
Sensitivity to hot or cold foods
*
0
1
2
3
Sores in your mouth
*
0
1
2
3
White patches on your tongue or cheeks
*
0
1
2
3
Swelling of the jaw
*
0
1
2
3
Your Score
*
Section B; Eosinophilic Esophagitis and Esophagitis
Problems with swallowing or painful swallowing (dysphagia)
*
0
1
2
3
Food gets stuck/impacted in esophagus after swallowing
*
0
1
2
3
Need to regurgitate or vomit food and/or nausea
*
0
1
2
3
GERD medications, such as proton pump inhibitors, don't help the problem
*
0
1
2
3
Chest or abdominal pain with eating
*
0
1
2
3
Heartburn or GERD
*
0
1
2
3
Your Score
*
Section C; Hypoacidity of the Stomach
Burping or bloating right after eating
*
0
1
2
3
Feels like food sits in your stomach
*
0
1
2
3
History of allergies or autoimmune disease
*
0
1
2
3
Easily get food poisoning
*
0
1
2
3
Stomach upsets easily
*
0
1
2
3
History of constipation
*
0
1
2
3
Known food allergies
*
0
1
2
3
iron deficiency anemia
*
0
1
2
3
Nausea after taking supplements
*
0
1
2
3
Undigested food in stool
*
0
1
2
3
History of small intestinal bacterial overgrowth
*
0
1
2
3
Age 75-79 =1 point, age 80-84=2 points, age >85=3 points
*
0
1
2
3
Takes antacids or Proton Pump Inhibitors (PPIs)
*
0
1
2
2
Pruritis ani (itchy anus)
*
0
1
2
3
Your Score
*
SectionD; Gastic Reflux
Sour taste in mouth
*
0
1
2
3
Regurgitate undigested food
*
0
1
2
3
Frequent Coughing
*
0
1
2
3
Burning sensation from citrus in throat
*
0
1
2
3
Heartburn
*
0
1
2
3
Burping
*
0
1
2
3
Difficulty swallowing solids or liquids
*
0
1
2
3
Your Score
*
Section E; Hypofunction of Small Intestine and/or Pancreas
Abdominal cramps
*
0
1
2
3
Indigestion one to three hours after eating
*
0
1
2
3
Fatigue after eating
*
0
1
2
3
Lower bowel gas
*
0
1
2
3
Alternating constipation and diarrhea
*
0
1
2
3
Diarrhea
*
0
1
2
3
Roughage and fiber causes constipation
*
0
1
2
3
Mucus in stools
*
0
1
2
3
Stool poorly formed
*
0
1
2
3
Shiny stool
*
0
1
2
3
Three or more large bowel movements daily
*
0
1
2
3
Dry, flaky skin and/or dry brittle hair
*
0
1
2
3
Pain in left side under rib cage or chronic stomach pain
*
0
1
2
3
Adult acne
*
0
1
2
3
Food allergies
*
0
1
2
3
Difficulty gaining weight
*
0
1
2
3
Foul-smelling stool
*
0
1
2
3
Gallstones/history of gallbladder disease
*
0
1
2
3
Undigested food in stool
*
0
1
2
3
Nauseea
*
0
1
2
3
Acid reflux/heartburn
*
0
1
2
3
Alcoholism, diabetes,osteoporosis
*
0
1
2
3
Connective tissue disorder: lupus, RA, Sjogren's
*
0
1
2
3
Your Score
*
Section F; Ulcers
Stomach pain
*
0
1
2
3
Stomach pains before or after meals
*
0
1
2
3
Dependency on antacids or PPIs for heartburn/GERD
*
0
1
2
3
Chronic abdominal pain
*
0
1
2
3
Butterfly sensations in stomach
*
0
1
2
3
Burping or bloating
*
0
1
2
3
Stomach pain when emotionally upset
*
0
1
2
3
Sudden, acute indigestion
*
0
1
2
3
Relief of symptoms by carbonated drinks
*
0
1
2
3
Relief of stomach pain by drinking cream/milk
*
0
1
2
3
History or family history of ulcer or gastritis
*
0
1
2
3
Current ulcer
*
0
1
2
3
Black stool when not taking iron supplements
*
0
1
2
3
Use or previous use of pain medications: aspirin, ibuprofen, etc.
*
0
1
2
3
Your Score
*
Section G; Enzyme Insufficiencies
Lactose intolerance, fructose intolerance or sucrose intolerance
*
0
1
2
3
Undigested food in your stools
*
0
1
2
3
Abdominal discomfort, bloating, gas
*
0
1
2
3
Bleeding tendency (vitamin K deficiency)
*
0
1
2
3
Can't gain weight
*
0
1
2
3
Fatigue for no obvious reason
*
0
1
2
3
Food sensitivities
*
0
1
2
3
Transient low blood sugar
*
0
1
2
3
Malabsorption issues
*
0
1
2
3
Pale or tan colored stools, may be frothy and smell bad
*
0
1
2
3
Stools that float
*
0
1
2
3
Your Score
*
Section H; Liver/Gallbladder
Trouble digesting food with fats and oils
*
0
1
2
3
Jaundice or yellow colored whites of eyes
*
0
1
2
3
Nausea and vomitng
*
0
1
2
3
Feeling queasy after a fatty meal
*
0
1
2
3
Feeling of fullness and deferred pain to head, belly, shoulder blades
*
0
1
2
3
Have had gallbladder removed or have gallstones
*
0
1
2
3
Light or tan colored, frothy stools, smell bad
*
0
1
2
3
Diarrhea
*
0
1
2
3
Gas or bloating
*
0
1
2
3
Low serum albumin levels
*
0
1
2
3
Bleeding tendency (vitamin K deficiency)
*
0
1
2
3
Less than one bowel movemnet daily
*
0
1
2
3
Itchy skin
*
0
1
2
3
Lack of appetite
*
0
1
2
3
Dark colored urine
*
0
1
2
3
Having a bitter taste or sour taste in your mouth after eating
*
0
1
2
3
Water retention in legs and ankles
*
0
1
2
3
Big toe painful
*
0
1
2
3
Pain radiates along outside of leg
*
0
1
2
3
Dry skin/hair
*
0
1
2
3
Red blood in stool
*
0
1
2
3
Have had jaundice or hepatitis
*
0
1
2
3
High blood cholesterol and/or triglycerides
*
0
1
2
3
Your Score
*
Section I; Food Sensitivities
Nausea
*
0
1
2
3
Diarrhea
*
0
1
2
3
Abdominal pain or discomfort
*
0
1
2
3
Neurological issues including brain fog, depression difficulty focusing or remembering
*
0
1
2
3
Rashes or hives
*
0
1
2
3
Unexplained fatigue, joint pain or muscle pain
*
0
1
2
3
Diagnosed with autoimmune disorder
*
0
1
2
3
Digestive issues
*
0
1
2
3
Your Score
*
Section J; Food Allergies
Itching, rash, hives or flushing
*
0
1
2
3
Itching or tingling in the mouth or in the tongue
*
0
1
2
3
Swollen lips, face, tongue, throat, etc.
*
0
1
2
3
Symptoms come on rapidlyafter eating
*
0
1
2
3
Chronic sinusitis
*
0
1
2
3
Nausea and/or abdominal cramping
*
0
1
2
3
Diagnosed with allergies: i.e. hay fever, asthma, eczema
*
0
1
2
3
Diarrhea
*
0
1
2
3
Dizziness
*
0
1
2
3
Your Score
*
Section; K Intestinal Permeability/Leaky Gut or Dysbiosis
Constipation and/or diarrhea
*
0
1
2
2
Abdominal pain or bloating
*
0
1
2
3
Mucus or blood in stool
*
0
1
2
3
Joint pain or swelling or arthritis
*
0
1
2
3
Chronic or frequent fatigue or tiredness
*
0
1
2
3
Food allergies or food sensitivities or intolerances
*
0
1
2
3
Sinus or nasal congestion
*
0
1
2
3
Chronic or frequent inflammation
*
0
1
2
2
Eczema, skin rashes or hives (urticaria)
*
0
1
2
3
Chronic nasal congestion
*
0
1
2
3
Asthma, hay fever, or airborne allergies
*
0
1
2
3
Confusion, poor memory, or mood swings
*
0
1
2
3
Use of non-steroidal anti-inflammatory drugs (aspirin, ibuprofin)
*
0
1
2
3
History of antibiotic use
*
0
1
2
3
Alcohol consumption, or alcohol makes you feel sick
*
0
1
2
3
Ulcerative colitis, Crohn's disease, or celiac disease
*
0
1
2
3
Headaches or migraine headaches
*
0
1
2
3
Your Scote
*
Section L; Small Intestinal Bacterial Overgrowth
Stomach pains
*
0
1
2
3
Stomach pains before or after meals
*
0
1
2
3
Abdominal bloating and distension, especially with sugar fiber or carbohydrates
*
0
1
2
3
Abdominal pain, cramping, mucous or blood in stools
*
0
1
2
3
Irritable bowel syndrome
*
0
1
2
3
Fibromyalgia
*
0
1
2
3
Restless leg syndrome
*
0
1
2
3
Intestinal cystitis
*
0
1
2
3
Chronic constipation
*
0
1
2
3
Intolerance to probiotic supplements
*
0
1
2
3
Scored 9 or more on section A
*
0
1
2
3
Currently taking antacids or proton pump inhibitors
*
0
1
2
3
Fatigue/Low energy
*
0
1
2
3
Depression or anxiety
*
0
1
2
3
Bad breath
*
0
1
2
3
Your Score
*
Section M; Dysbiosis: Fungal Overgrowth
Recurring vaginal, nail, skin or other fungal infections
*
0
1
2
3
Diarrhea, constipation or both
*
0
1
2
3
Unexplained fatigue and/or brain fog
*
0
1
2
3
Depression and/or anxiety
*
0
1
2
3
Chronic sinusitis
*
0
1
2
3
Itching in vagina, anus, ears, or other mucus membranes
*
0
1
2
3
Gas and/or bloating
*
0
1
2
3
Diagnosis of autoimmune disease
*
0
1
2
3
Skin issues: eczema, psoriasis, hives, rashes
*
0
1
2
3
Low blood sugar issues, mood swings
*
0
1
2
3
Your Score
*
Section N; Celiac Disease, Gluten
Sensitivity, Wheat Reactions
Digestive
Bloating and/or gas
*
0
1
2
3
Constipation and/or diarrhea
*
0
1
2
3
Nausea
*
0
1
2
3
Weight Trouble
*
0
1
2
3
iron-deficiency anemia
*
0
1
2
3
Hormonal
Fatigue
*
0
1
2
3
Sleep problems
*
0
1
2
3
Depression, anxiety and/or mood swings
*
0
1
2
3
Menstrual problems
*
0
1
2
3
Infertility
*
0
1
2
3
Thyroid problems
*
0
1
2
3
Osteoporosis or osteopenia
*
0
1
2
3
Neurological
Headaches and/or migraines
*
0
1
2
3
Memory problems
*
0
1
2
3
Joint pains or aches
*
0
1
2
3
Fibromyalgia
*
0
1
2
3
Brain fog
*
0
1
2
3
Immune System
Get infections easily
*
0
1
2
3
Arthritis, any type, you or family
*
0
1
2
3
Cancer history, you or family
*
0
1
2
3
Autoimmune disease, you or family
*
0
1
2
3
Celiac disease, you or family
*
0
1
2
3
Your Score
*
Section O; Colon/Large Intestine
Seasonal or recurring diarrhea
*
0
1
2
3
Frequent and recurrent infections (colds)
*
0
1
2
3
Bladder and kidney infections
*
0
1
2
3
Vaginal yeast infections
*
0
1
2
3
Abdominal cramps
*
0
1
2
3
Toe and fingernail fungus
*
0
1
2
3
Alternating diarrhea/constipation
*
0
1
2
3
Constipation
*
0
1
2
3
History of antibiotic use
*
0
1
2
3
Meat eater
*
0
1
2
3
Rapidly failing vision
*
0
1
2
3
Recurrent stomach pain
*
0
1
2
3
Blood or pus in stool
*
0
1
2
3
Family history of IBD
*
0
1
2
3
Your Score
*
Submit
Welcome
Meet Dr. Harris
Do You Feel Lucky
Our Philosophy
Professional Affiliations
Paperwork
Health History
Digestive and Lifestyle Symptoms Assessment
Digestive Health Appraisal Questionairre
Female Hormone Self Assessment
Male Hormone Self Assessment
Medical Symptoms Questionaire
Nutritional Assessment
Gluten Sensitivity Assessment
Dairy Sensitivity
Toxin Exposure Assessment
Toxic Burden
Clinical Clues of Low Stomach Acid
Leaky Gut/Intestinal Permeability
>
Candida Assessment
Causes of Leaky Gut Syndrome
Programs
Eye to Eye
>
All Inclusive
Life in the Middle
Pay as You Go
From a Distance
>
All Inclusive
Life in the Middle
Pay as You Go
Diet Lifestyle Environment
Diet
Lifestyle
Environment
Resources
Book; Our Modern Mortal Trilogy
Detox and Meal Replacement
Comprehensive Elimination Diet
Daily/Weekly Physical Activity
Food Diary
>
Daily/Weekly Food Diary
Recipe's
>
Snacks/Appetizers/Soups
Entrees
>
Breakfast
Lunch
Dinner
Salads/Desserts
All Things Coconut
Out of the Box NEK TV
Newsletters
FAQ
A List of Lists
Answers to QUARA
Blog
Power Point Presentations
Cancer
Cancer