Quiz - Inspired Health Center

Start Here
- Start Here
- Free Program
MEMBER CENTER
- New Patient Forms
- Members Area
Success Stories
SERVICES
Events
- Inspired Health Event Calendar
- Functional Forum Meetups
Blog
Giving Back
About Us

Is Inspired Health Center Right For You?

INSPIRE. EMPOWER. CHANGE
SCHEDULE A CONSULTATION

Quiz

Step 1 of 5 - Step 1

0%

Please select all that apply*
- Select All
- Are you being told everything looks "normal" but don't feel well?
- Are you confused with all the conflicting information online?
- Is your current state of health preventing you from doing the things you enjoy?
- Are you seeking the ROOT CAUSES?
- Are you looking for a more comprehensive approach?
- Are you looking for accountability?
- Are you looking for a team that is empathetic and supportive?
- Are you willing to take responsibility over your health?
- Do you want more energy?
- Do you feel tired when reading a book?
- Do you feel tired when driving for longer distances?
- Do you feel tired after a short duration of activity?
- Are you tired when you wake up in the morning?
- Do you need stimulants to wake you up or keep going?
- Is your energy inconsistent throughout the day?
- Do you take longer than before to recover from exercise or illness?
- Are you sensitive to chemicals like perfumes, exhaust fumes, or cleaning products?
- Do you have a history of medication use?
- Do you have high liver enzymes?
- Do you lose weight and quickly gain it back?
- Have you been exposed to industrial chemicals at work?
- Do you eat a diet that is NOT organic or eat processed and packaged foods?
- Have you recently bought a new home, car, furniture, or carpeting?
- Do you spend a lot of time indoors?
- Is there any yellowing of your eyes?
- Do you have elevated triglycerides?

Save and Continue Later

Please select all that apply*
- Select All
- Are you noticing a decline in your memory (short or long term)?
- Do you walk into a room and forget why?
- Are your math skills declining?
- Do you have a hard time with directions?
- Are you having a hard time learning new tasks?
- Do you dream at night but forget your dreams?
- Do you have a history of high or low blood sugars?
- Do you ever feel depressed or anxious?
- Do you have a hard time focussing?
- Have others noticed a change in your mood or behaviour?
- Do you have a hard time starting and finishing tasks?

Save and Continue Later

Please check all that apply*
- Select All
- Do you feel like stress is affecting your life?
- Do you feel tired in the morning after enough sleep?
- Do you wake up between 2-4am in the morning?
- Do you feel tired between 2-4pm and need caffeine to keep going?
- Have you suffered any major losses recently or in the past that have not been addressed?
- Do you have emotional instability?
- Do you feel exhausted shortly after you exercise?
- Do you crave sugar, salts, and fats?
- Do you feel like your sleep is broken?
- Do you carry weight in the mid-section that is hard to lose?
- Do you feel like you don't have time for yourself?
- Do you feel anxious?
- Is your motivation not what it used to be?
- Do you experience hot flashes?
- Do you have PMS?
- Do you experience mood swings?
- Has your libido (sex drive) dropped?
- Do you experience aches and pains that don't seem to go away?

Save and Continue Later

Please check all that apply*
- Select All
- Do you experience a lot of stress at work?
- Have you ever been abused (physically or emotionally)?
- Do you have a supportive network of friends and family?
- Has your home been water damaged?
- Do you spend less than 4 hours in nature per week?
- Is your job sedentary?
- Do you spend more than 4 hours in front of a computer per day?
- Do you go to bed after 10pm?
- Do you carry your cell phone with you at all times?
- Do you have a hard time practicing meditation, deep breathing, or other relaxation techniques?
- Do you have a hard time sticking to an exercise/activity program?

Save and Continue Later

First Name*
Last Name*
What is the best email address to discuss next steps?*
Please list your top 3 health goals*
What is the best number to reach you?*
How did you hear about us?*
Phone
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Δ

Archives

Meta

Log in
Entries feed
Comments feed
WordPress.org

Recent Posts

(no title)
Defeat Neuropathy!
What is my favorite local restaurant?!
Dr. Justin Coop Featured in Glancer Magazine!
Patient of the Month- Kat

Recent Comments

Hannah on Hormonal Problems and Thyroid Malfunction

Categories

Adrenal Fatigue
Anti-Aging
Brain Function
Chronic Stress
Digestion
Doctor's Notes
Fibromyalgia
Health Education
Health Fun Facts
Health Fun Facts
Healthy Aging
Heart Health
Hormones
Inspire / Motivate
Nutrition & Food
Nutrition & Food
Office News
Pain Management
Personal
Sleep Disorders
Stress Hormones and Health
Videos
Weight Loss