Metabolic Assessment Form™

  • Part I Please list your 5 major health concerns in order of importance:
  • Part II Please circle the appropriate number on all questions below. 0 as the least/never to 3 as the most/always.
  • Category I: Colon
  • Category II: Chemical Tolerance
  • Category III: Stomach
  • Category IV: Biliary
  • Category V: Hepatic Detoxication
  • Category VI: Peripheral Utilization of Sugars
  • Category VII: Adrenal
  • Category VIII: Adrenal
  • Category IX: Thyroid
  • Category X: Thyroid
  • Category XI: Prostate (Males Only)
  • Category XII: Menstruating Women
  • Category XIII: Menopausal Women
  • Part III
  • Part IV