top of page
Create your selfmap® by providing the info below
How would you describe your diet?
What do your meals contain?
How often do you have bowel movements?
Do you feel bloated or backed up regularly?
How often do you exercise?
Do you experience loss of energy at certain time of day or after meals?
How many hours of sleep do you get each night?
Do you wake up feeling completely rested?
Do you experience mood swings over course of the day?
Do you experience performance issues during sexual activities?
What are your top 3 health concerns?
Concern #1
When did it start _______ years ago?
What seemed to be the initial cause?
What aggravates and/or improves the condition?
Are you under medical and/or therapeutic treatment for this condition?
Concern #2
When did it start _______ years ago?
What seemed to be the initial cause?
What aggravates and/or improves the condition?
Are you under medical and/or therapeutic treatment for this condition?
Concern #3
When did it start _______ years ago?
What seemed to be the initial cause?
What aggravates and/or improves the condition?
Are you under medical and/or therapeutic treatment for this condition?
An error occurred. Try again later
Your content has been submitted
bottom of page