Dr. Wallach's Health Evaluation

Please rate yourself on the health symptoms below. If you never have that symptom just leave it blank. 1= Rarely, 2= Occasionally, 3= Often, 4= Almost Always, 5= Severe.

Category 1 - Hard Tissue Problems

Category 1 Total:

Category 2 - Soft Tissue Problems

Category 2 Total:

Category 3 - Blood Sugar Problems

Category 3 Total:

Category 4 - Digestion Problems

Category 4 Total:

Health Problem Total

Health Problem Total:

Other Health Questions

Do you want to lower the scores above without drugs or surgery? *
Are you interested in strengthening your immune system? *
Are you interested in increasing your energy levels? *
Are you interested in losing weight? *
Are you interested in Heart Disease Prevention? *
Are you interested in Cancer Prevention? *
Do You Prefer Good Tasting Health Drinks or Tablets? *
Do You Have a Dog or a Cat? *

Based on the answers above, what are your 3 most important health goals right now?