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Healing Body, Mind and Spirit

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7 Basic Steps to Total Health Questionnaire


All fields marked with a * are required:

1). Air

How old is your house?

10 years or less.

11 years or more.

Do you have carpet in your house?

Do you have carpet in your bedroom?

Do you have an attached garage?

Do you keep cleaning supplies in the house or attached garage?

Do you use standard cleaning supplies?

Do you keep paints and other chemicals, sprays, liquids, building materials, etc. stored in the house or attached garage?

Do you have drapes in your house?

Do you have drapes in your bedroom?

Do you sleep on a standard mattress?

Do you sleep with either a down, foam or fiber filled standard pillow?

Do you use standard cotton pillow cases and sheets?

Do you have newer furniture, 10 years or newer?

Do you use a standard vacuum cleaner?

Do you smoke?

Have you painted any inside walls within the last 5 years?

2). Water
Do you have a filter on your shower, sinks and bath?

Do you drink:

Tap water?

Bottled water

Spring water

Reverse osmosis

Distilled water

Distilled post carbon filtered

Do you drink beverages with ice cubes that are made from:

Tap water?

Bottled water

Spring water

Reverse osmosis

Distilled

Distilled post carbon filtered

3). Food

Percentage of your diet that is living/raw uncooked enzyme and bioenergetic rich plant foods?

0%

0-25%

25-50%

50-75%

75-100%

100%

Do you eat meat, meat products, chicken and eggs?

1-3 serving per week

4-7 servings per week

8-12 serving per week

More than 12 servings per week

Do you eat fish?

1-3 servings per week

4-7 servings per week

8-12 servings per week

12+ servings per week

Do you eat or drink dairy products?

1-3 servings per week

4-7 servings per week

8-12 servings per week

12+ servings per week

Do you eat refined flours, rolls, chips, pretzels, bread or pasta?

1-3 servings per week

4-7 servings per week

8-12 servings per week

12+ servings per week

Do you eat refined sugar/sugar containing cookies, cakes, donuts, or soda?

1-3 servings per week

4-7 servings per week

8-12 servings per week

12+ servings per week

Do you drink coffee?

1-3 servings per week

4-7 servings per week

8-12 servings per week

12+ servings per week

Do you drink alcohol?

1-3 servings per week

4-7 servings per week

8-12 servings per week

12+ servings per week

Do you eat foods artificially sweetened with Nutrisweet or Saccharin?

1-3 servings per week

4-7 servings per week

8-12 servings per week

12+ servings per week

4). Sleep

Does the bed frame have any metal in it?

Do you sleep with a standard foam, fiber filled or down pillow?

Do you sleep on standard cotton pillow cases and sheets?

Do you sleep with a standard fiber or downfilled comforter?

Do you wake up with back or neck stiffness, tightness or pain?

Do you have carpet in the bedroom?

Do you have drapes in the bedroom?

Do you have any noticeable or visible light in the bedroom at night when you go to sleep (ie: nightlight, streetlights, etc.)?

Do you toss and turn throughout the night? (evidenced by sheets, pillow and comforter position in the morning)

Have you checked the EMF (electromagnetic field) level in your bedroom and are they 1 mg or above?

Do you sleep on a standard store bought mattress?

Do you sleep less than :

9.5 hours per night

8.5 hours per night

7.5 hours per night

6.5 hours per night

5.5 hours per night

4.5 or less per night

Do you wake up during the night?

1 time

2 times

3 times

4 or more times

How many minutes does it take you to fall asleep?

10-20 minutes

20-30 minutes

30-40 minutes

40 + minutes

Do you sleep on your:

Stomach?

Side?

Back?

Is the mattress:

Coil?

Foam

Air

Water

5). Exercise

Do you exercise your cardiovascular system by walking at least 30 minutes?

0 times per week

1-2 times per week

3-4 times per week

5-6 times per week

7 times per week

Do you exercise your immune system and your lymphatic for detoxification or cleansing of the tissues with rebounding (cellular/lymphatic exercise)?

0 times per week

1-2 times per week

3-4 times per week

5-6 times per week

7 times per week

Do you do strengthening exercises?

0 times per week

1-2 times per week

3-4 times per week

5-6 times per week

7 times per week

Do you do stretching exercises?

0 times per week

1-2 times per week

3-4 times per week

5-6 times per week

7 times per week

6). DETOXIFY/CLEANSE/PURIFY

Are you drinking less than 32 ounces per 50/lbs body weight per day?

Do you eat an animal product, chemical cooked diet?

You do not do a detoxifying/cleansing program every 3 months for your bowel.

You do not do a detoxify/cleanse/purify program every 3 months for your liver/gull bladder.

You do not do a detoxify/cleanse/purify program every 6 months for your kidney/bladder.

You do not do a detoxify/cleanse/purify program every 6 months for your blood.

You do not stay indefinitely on a bowel and liver maintenance program.

Are you wearing standard makeup cosmetics?

Are you using standard skin care products?

Are you using standard deodorants or antiperspirants?

Are you using standard perfume/cologue?

Are you wearing standard synthetic, cotton, wool, silk clothing?

EMF’s

Have you checked your house, car and workplace for EMF levels and are they under:

0.5 milligaus

.5-1 MG

1-2 MG

2-4 MG

6-8 MG

8 + MG

7). PRAYER/MEDITATION/STILLNESS

You do not spend time each day in quiet prayer and meditation?

You do not know how to still your conscious thinking mind so you can hear God speak to your heart with His love, joy, peace and hope?

Do you not know how to live life fully in the present moment?

Do you not know how to rest in the “being” instead of the “doing”?

You do not know how to let go of things that you are addicted to, ie: food?



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