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
Medical Symptoms Questionaire
c
*
Indicates required field
Name
*
First
Last
Phone Number
*
Date
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Occupation
*
Height
*
Weight
*
Marital Status
*
Single
Married
Divorced
Separated
Partner
Widow(er)
Number of Children
*
Email
*
Date of Birth
*
Gender
*
Male
Female
C
heck all conditions/symptoms that apply to you within the past 30 days
Do you currently suffer from HEAD
*
Frequent Headaches
Dizziness
Faintness
Insomnia
Do you currently suffer from; Eyes
*
Watery or Itchy eyes
Swollen, reddened or sticky eyelids
Bags or dark circles under eyes
Blurred or tunnel vision (does not include near or farsightedness
Comments
*
Comment
*
Do you currently suffer from; Ears
*
Itchy ears
Earaches, ear infections
Drainage from ear
Ringing in ears, hearing loss
Do you suffer from; Nose
*
Stuffy nose
Sinus problems
Hay fever
Sneezing attacks
Excessive mucus formation
Comment
*
Comment
*
Do you suffer from; Skin
*
Acne
Hives,rashes, dry skin
Hair loss
Flushing, hot flashes
Excessive sweating
Do you suffer from; Mouth/Throat
*
Chronic coughing
Gagging,frequent need to clear throat
Sore throat, hoarseness, loss of voice
Swollen or discolored tongue, gums, lips
Canker sores
Comment
*
Comment
*
Do you suffer from; Heart
*
Irregular or skipped heartbeat
Rapid or pounding heartbeat
Chest pain
Do you suffer from; Lungs
*
Chest congestion
Asthma,bronchitis
Shortness of breath
Difficulty breathing
Comment
*
Comment
*
Do you suffer from; Digestive tract
*
Nausea, vomitng
Diarrhea
Consipation
Bloated feeling
Belching, passing gas
Heartburn
Intestinal/stomach pain
Do you suffer from; Joint/Muscle
*
Pain or aches in joints
Arthritis
Stiffness or limitation of movement
Pain or aches in muscles
Feeling of weakness or tiredness
Comment
*
Comment
*
Do you suffer from; Weight
*
Binge eating/drinking
Craving certain foods
Excessive weight
Compulsive eating
Water retention
Underweight
Comment
*
Do you suffer from; Energy/Activity
*
Fatigue, slugishness
Apathy,lethargy
Hyperactivity
Restlessness
Comment
*
Do you suffer from; Mind
*
Poor memory
Confusion, poor comprehension
Poor concentration
Poor physical coordination
Difficulty in making decisions
Stuttering or stammering
Slurred speach
Learning disabilities
Do you suffer from; Emotions
*
Mood swings
Anxiety, fear,nervousness
Anger,irritability, aggtressiveness
Depression
Comment
*
Comment
*
Do you suffer from; Other
*
Frequent Illness
Frequent or urgent urination
Genital itch or discharge
Comment
*
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