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Form
1.
Name
2.
Email
3.
Let us know if you want to receive the results of this survey.
4.
Yes, email me the results.
No, I'm just looking.
5.
For the average person 80% of the cholesterol in their system is produced by the liver. If the liver is not producing the exact amount needed you might have High cholesterol or imbalanced cholesterol. What is your HDL "good cholesterol" Level? (please give number-- not "its okay" or "normal". If you do not know, please put "I do not know")
6.
What is your LDL "bad cholesterol" Level? please give number-- not "its okay" or "normal". If you do not know, please put "I do not know")
7.
What is your VLDL "VERY Low Density Lipoproteins" Level? please give number-- not "its okay" or "normal". If you do not know, please put "I do not know")
8.
Triglycerides are a byproduct of poor digestion, due to the liver therefore, blood clots are also usually caused by a liver which is sluggish. Therefore a blood clot to the heart causes a heart attack and one to the brain causes a stroke. What is your triglyceride level? please give number-- not "its okay" or "normal". If you do not know, please put "I do not know")
9.
High PSA or prostate problems are strongly linked to the liver's inability of filtering out mutated hormones. Do you have any symptoms of a prostate problem or high PSA?
Never
Not Now-In the past
Seldom
Often
10.
Sensitivity to chemicals and allergies can be linked directly to the liver. Do you suffer from either sensitivity or allergies to chemicals or foods?
Never
Not Now-In the past
Seldom
Often
11.
Liver is involved in digestion. Do you experience bloating or gassiness or flatulence more than once a week?
Never
Not Now-In the past
Seldom
Often
12.
The liver helps regulate blood sugar levels along with the pancreas and adrenals. Symptoms that the liver is not balancing blood sugar levels include: Do you get either shaky, weak, grouchy or aggressive if you skip a meal?
Never
Not Now-In the past
Seldom
Often
13.
.....Abnormal appetite?
Never
Not Now-In the past
Seldom
Often
14.
........Feeling like taking a nap after you have eaten a large meal?
Never
Not Now-In the past
Seldom
Often
15.
...........If you wake up during the night to urinate or look at the clock or any other reason, the liver is probably releasing a little bit of sugar when it detoxifies. Do you wake up at night?
Never
Not Now-In the past
Seldom
Often
16.
The liver also regulates how the body gets rid of toxins. The favorite eliminating system is through the skin. Have you developed rashes, psoriasis, eczema, boils or acne (which means the liver is putting the toxins out through the skin)?
Never
Not Now-In the past
Seldom
Often
17.
Do you have moles and/or skin tags?
Never
Not Now-In the past
Seldom
Often
18.
It is also the liver's job to release what stimulates the bowels to empty. Do you have less than 1 bowel movement for every meal that you eat?
Never
Not Now-In the past
Seldom
Often
19.
Do the muscles in your neck/shoulder area often become tight?
Never
Not Now-In the past
Seldom
Often
20.
The liver produces Vitamin A out of beta-carotene (as in carrots). Have you experienced any of the common symptoms of a Vitamin A deficiency such as: wounds healing with a thick scaring, or adhesions?
Never
Not Now-In the past
Seldom
Often
21.
The liver produces Vitamin E out of wheat or soy. Do you have any common Vitamin E deficiencies such as tightness in the calves of the legs when you stand/climb steps/ladder and/or have hot flashes?
Never
Not Now-In the past
Seldom
Often
22.
The liver converts sugar it can not store into fat and place it around the midsection of the stomach. If you gain weight does it settle around the stomach?
Never
Not Now-In the past
Seldom
Often
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