1. Your Health Assessment

This health assessment is designed to indicate if you are a good candidate for our services.  

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* 1. In general, how would you rate your overall health?

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* 2. What is your height in feet and inches? For example, if you are 5 feet and 4 inches, write 5’4”.

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* 3. What is your current weight in pounds?

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* 4. How many hours do you sleep each night?

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i We adjusted the number you entered based on the slider’s scale.

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* 5. About how many times in the average week do you exercise? (i.e. walking, running, going to the gym.  Not including work or chores)?

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* 6. How much water do you drink a day?

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* 7. Do you get headaches?

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* 8. Do you have neck or back pain?

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* 9. How would you rate your posture? (Did you know your posture can effect your mental attitude?)

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* 10. Is your health or how you feel keeping you from doing things that you love to do? (i.e. Playing with you kids or grandkids, keeping you from your hobbies, effecting you at work.)

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* 11. Do you experience any Anxiety or Depression?

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* 12. Do you feel like if you don't do anything about your condition that its only going to get worse? 

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* 13. Are you interested in a Complementary Consultation to sit down with our Doctor and discuss ways to improve your health?

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* 14. Every Tuesday night @ 6:00pm Dr. James does a 45 minuet lecture on "7 secrets to better health and healing" Would you like an invitation to attend?

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* 15. I would like Dr. James to contact me to discuss my results. 

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* 16. Please fill out your contact information if you would like us to contact you.

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