Wellness Consult

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IT'S TIME YOU HAD A GAMEPLAN FOR YOUR HEALTH.

Ready to take your health and wellness to the next level?

Want a personalized plan that actually prioritizes your wellness without disrupting your life?

Apply for a free wellness consult with me now.

READY FOR YOUR WELLNESS GAMEPLAN?

To prepare for your free consult, please complete the application below.

Score each statement below based on your own personal experience.

The intent of this tool is for educational purposes only. This is not intended to diagnose, treat or prescribe. These statements have not been evaluated by the FDA.

[c] Poor concentration or memory*

Never

Occasionally

Often

Almost Always

[c] Cold hands & feet*

Never

Occasionally

Often

Almost Always

[c] Frequent consumption of fried foods*

Never

Occasionally

Often

Almost Always

[c] Sedentary lifestyle*

Never

Occasionally

Often

Almost Always

[c n] Smoking / Vaping*

Never

Occasionally

Often

Almost Always

[d] Food allergies / difficulty digesting certain foods*

Never

Occasionally

Often

Almost Always

[d] Heavy coating on tongue*

Never

Occasionally

Often

Almost Always

[d] Belching, gas or discomfort after meals*

Never

Occasionally

Often

Almost Always

[d] Fewer than 2 bowel movements per day*

Never

Occasionally

Often

Almost Always

[em] Feeling drained*

Never

Occasionally

Often

Almost Always

[em] Express emotions in unhealthy ways*

Never

Occasionally

Often

Almost Always

[em en] Feeling irritable, anxious, moody or down*

Never

Occasionally

Often

Almost Always

[em] Feeling that life has little or no purpose*

Never

Occasionally

Often

Almost Always

[en] Crave or consume sweets, salty or junk foods*

Never

Occasionally

Often

Almost Always

[en rp] (women) Monthly female issues*

not applicable

Never

Occasionally

Often

Almost Always

[en] Restless sleep or lack of sleep*

Never

Occasionally

Often

Almost Always

[ex] Puffiness under eyes*

Never

Occasionally

Often

Almost Always

[ex] Frequent or painful urination/urinary issues*

Never

Occasionally

Often

Almost Always

[ex] Diet high in meats and grains*

Never

Occasionally

Often

Almost Always

[ex m] Sore, painful or weak joints/bones*

Never

Occasionally

Often

Almost Always

[im rs] Frequent illness (more than twice a year)*

Never

Occasionally

Often

Almost Always

[im] Frequent use of antibiotics*

Never

Occasionally

Often

Almost Always

[im] Less than 3 servings of fruits & veggies per day*

Never

Occasionally

Often

Almost Always

[c em im] Stressful lifestyle*

Never

Occasionally

Often

Almost Always

[in] Dry, brittle nails*

Never

Occasionally

Often

Almost Always

[in] Complexion or other skin issues*

Never

Occasionally

Often

Almost Always

[in] Rashes, lesions or bruise easily*

Never

Occasionally

Often

Almost Always

[in m] Dry, brittle or thinning hair*

Never

Occasionally

Often

Almost Always

[l] Lack of energy or chronic fatigue*

Never

Occasionally

Often

Almost Always

[l] Exercise less than 2 times per week*

Never

Occasionally

Often

Almost Always

[l] Swelling or inflammation*

Never

Occasionally

Often

Almost Always

[l] Unexplained chronic issues (headache, skin, etc)*

Never

Occasionally

Often

Almost Always

[m n] Tremors, muscle cramps or spasms*

Never

Occasionally

Often

Almost Always

[m] Limited mobility*

Never

Occasionally

Often

Almost Always

[m n] Regularly consume alcohol or caffeine*

Never

Occasionally

Often

Almost Always

[n] Numbness or tingling*

Never

Occasionally

Often

Almost Always

[rp] Low sex drive*

Never

Occasionally

Often

Almost Always

[rp] (men) Impotence or prostate issues*

not applicable

Never

Occasionally

Often

Almost Always

[rp] Hot flashes, sweats, irregular body temperature*

Never

Occasionally

Often

Almost Always

[rs] Exposure to air pollutants*

Never

Occasionally

Often

Almost Always

[rs] Puffiness under eyes*

Never

Occasionally

Often

Almost Always

[rs] Heavy mucus production or congestion*

Never

Occasionally

Often

Almost Always

[rs] Difficulty breathing or frequent cough*

Never

Occasionally

Often

Almost Always

Indicate the amount you will budget monthly to achieve your wellness goals?*

$50 - 100

$100 - 200

$200 - 300

$300+

Anything else you'd like me to know before our call?

Dr. Nozella Brown

USA
(913) 379-4301 • nozella@naturallynozella.com

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