Health Consultation – Let us help you!Let us assist you in selecting the nutritional and/or personal care products that may help you. All information submitted will remain private and confidential. What are you looking for in your search for good health?Weight LossSkin ImprovementsWeight MaintenanceHealth ImprovementsWeight GainIf looking for weight management, how much weight are you serious about losing/gaining?Weight to Lose / Gain:Your Current Weight:Your Height:Your Age:Do you suffer from any of the following diet related ailments? (choose all that apply)AcneAllergiesArthritisAsthmaBronchitisBurnsCancerCandidaCelluliteCholesterolChronic-Fatigue SyndromeCirculatoryColitisConstipationCrohns DiseaseDepressionDiabetesDigestiveDiverticulitisEczemaFibromyalgiaGall-StonesGasGoutHeadachesHeartburnHepatitisHiatus-HerniaHigh-BP (Hypertension)Hyperactivity (ADD or ADHD)HypoglycemiaIBS (Irritable-Bowel Syndrome)JointsKidney-StonesLow-EnergyLupusMS (Multiple Sclerosis)MenopauseMenstrualMigrainesMuscle-TensionOsteoporosisPMS (Premenstrual Syndrome)PainPoor HealthRespiratorySleeping-DisordersSpasmsStressSurgery-RecoveryThyroidTriglyceridesUlcersUrinary/BladderVaricose-VeinsWeak Immune SystemYeast-InfectionsIf required, check the boxes that best describe your skin. (select those that apply)Fine dry lines around eyes and mouth, dehydration lines on face.Cheek area is dull, dry, taut.Skin is very sensitive to sun, wind and pollution.Slightly oily sheen on T-zone area - Not extreme.Drier cheek area.Occasional pimples and spots.Oily sheen on T-zone area and cheeks.Enlarged pores and blackheads evident.Pimples and spots frequent.Name:Email Address *Phone *Postal Address:CityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweAre there any additional comments you wish to add to aid our evaluation of your health needs?Send MessagePlease do not fill in this field.