| 1. | Do you enjoy physical activity such as a brisk, one mile walk? |
| 2. | Do you ever feel chilly or have cold skin on any body part? |
| 3. | Do you have a set mealtime? Do you think you eat too much? |
| 4. | Do you frequently have colds? |
| 5. | Do you use tobacco? alcohol? caffeine? medication? |
| 6. | Do you fall asleep when sitting still? How many hours of sleep do you get per night? What time to you go to bed at night? |
| 7. | Do you have pain or discomfort in head? trunk? or extremities? |
| 8. | Do you have one or more bowel evacuations daily? how many? |
| 9. | Do you have pale urine? how many glasses of water do you drink daily? |
| 10. | Do you have allergies? Hay fever? Skin problems? Sinusitis? |
| 11. | Do you have frequent infections? or accidents? |
| 12. | Do you ever feel depressed or gloomy? |
| 13. | Do you frequently have gas? indigestion? |
| 14. | Are you developing your mental and spiritual capabilities by daily study, meditation and prayer? |
| 15. | Would you like to be instructed in how to restore your health and prevent sicknesses and diseases naturally? |
