| Document Date: 2012-01-20 12:38:37
Open Document File Size: 1,66 MBShare Result on Facebook
Currency USD / / Facility California Health Center / / MedicalCondition colon cancer / Abdominal pain / pain / allergies / numbness__________ Heartburn_________ Heart condition________ Heart disease / Fatigue / injury / Diabetes____________ Diarrhea___________________ Diverticulitis___________ Dizziness / Gallbladder disease / disease / seizures__________ Irritable bowel syndrome / Body odor_________ Bowel impaction_____________ Breast pain_________ Bronchitis__________________ Bruise easily________ Cancer / Hepatitis__________ Hernia / illness / Ears ringing_______ Edema___________ Emphysema___________ Enlarged thyroid________ Fainting spells______ Fatigue / fissures_________ Foot numbness______ Frequent headaches / Arthritis________ Arteriosclerosis / Hemorrhoids / Back pain / Bloating / Anemia / Sleep Disorders_______ Ulcerative colitis / Diagnose diseases / stool__________________ Chest pain__________ Chronic cough___________________ Colitis_____________ Crohn’s disase___________________ Constipation / Asthma / / MedicalTreatment enemas / surgery / Colon Hydrotherapy / / Organization California Health Center / / Position Physician / therapist / Certified Therapist / / ProvinceOrState California / /
SocialTag |
4 Colonic Wellness Client Questionnaire: Name: ___________________________________________ Date____________