Secondary Health Appraisal Questionnaire

Please circle the number that best describes the frequency of your symptoms over the previous month, or answer the yes/no questions by circling the appropriate letter.
  • SECTION 1 - GASTROINTESTINAL

  • Section 1.1 - Stomach: Hypoacidity

  • Section 1.2 - Stomach: Hyperacidity

  • Section 1.3 - Small Intestine/Pancreas

  • Section 1.4 - Colon

  • Section 1.5 - Liver / Gallbladder / Pancreas

  • SECTION 2: ENDOCRINE

  • Section 2.1 - Symptoms of underactive thyroid

  • Section 2.2 - Symptoms of overactive thyroid

  • Section 2.3 - Stress, fatigue and adrenals

  • SECTION 3: IMMUNE

  • Section 3.1 - Low immunity

  • Section 3.2 - Allergy

  • SECTION 4: DETOXIFICATION (capacity)

    As far as you are aware, do you have a sensitivity or allergy to...
  • SECTION 5: GENERAL HEALTH HISTORY