Annual Physical Exam

Annual Physical Exam


  • We will be reminding you of your appointments via email. Please provide a private and valid email address you check regularly.
  • PHYSICAL HEALTH
  • How many servings per day do you eat? (Use a per/week estimate if not everyday)
  • MENTAL EMOTIONAL HEALTH
  • SPIRITUAL HEALTH
  • REVIEW OF MEDICAL SYMPTOMS
    Rate each of the following symptoms based upon your typical health profile for the past 30 days. Point Scale:
    0 – Never or almost never have the symptom
    1 – Occasionally have it, effect is not severe
    2 – Occasionally have it, effect is severe
    3 – Frequently have it, effect is not severe
    4 – Frequently have it, effect is severe
  • GENERAL
  • SKIN
  • ALLERGY/IMMUNE
  • EAR/NOSE/THROAT
  • EHEAD/EYES
  • HEART
  • LUNGS
  • DIGESTION
  • MUSCULOSKELETAL
  • NEUROLOGIC
  • MENTAL & PHYSICAL ENERGY
  • DIETARY
  • Additional Symptoms Review - MALE
  • Additional Symptoms Review - FEMALE