Health Goals for 2018 Question Title * 1. What are your health concerns? OK Question Title * 2. What are your health goals? OK Question Title * 3. Do you have Low Energy? Often Occasionally No OK Question Title * 4. Do you have Brain Fog? Yes Occasionally No OK Question Title * 5. Do you have Gastrointestinal Issues? Yes Occasionally No OK Question Title * 6. Do you have Muscle or Joint issues? Yes Occasionally No OK Question Title * 7. Do you have Allergies to Food or the Environment? Yes Occasionally No OK Question Title * 8. Do you have concerns about heart disease or diabetes? Yes No I have a family history but I am not concerned OK Question Title * 9. Would you like us to send you functional medicine information about any health topic? If yes, include topic and email. Yes No Maybe later, I will contact your clinic Other (please specify) OK DONE