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FORMS & QUESTIONNAIRES
Web Page Summary, Definition and Locations
Questionnaires are documents used by Dr. Smith for analysis and design of clinical nutrition supplement, dietary and/or specialized programs.
Forms are documents used by clients to record and/or score their actions in implementing or applying instructions from Dr. Smith for accountability and provide feedback to assist Dr. Smith in monitoring their program implementation and healing progress.
Summary and Location: The last section of this web page provides a quick link to all of the web pages listed below.
Educational Materials, Forms and Questionnaires posted on our web site are classified in two categories: 1) All Clients and 2) Special Services. "All Client" web pages may be opened with the same passcodes that opened this web page and are available to all clients. The "Special Services" Web Pages each have different passcodes and codes are provided upon payment for the special service. Each web page has been listed by its title in the Table of Contents (left column) that appears on each web page in our web site.
NEW CLIENT INSTRUCTIONS - This web page contains all instructions, articles, forms and questionnaires in a step-by-step format for the New Client Initial Assessment.
FORMS AND QUESTIONNAIRES - This web page has three pop-up webpages linked to it:
"All Forms & Questionnaires" web page is an alphabetically listing of all general client forms and questionnaires.
"Progress Reporting" web page provides quick access to forms used specifically for Progress Reporting.
"Retesting" web page provides quick access to forms and questionnaires to be completed each time your biochemistry (blood, urine, hair, saliva or stool) is retested and/or Nutritional Evaluation, such as the Health Appraisal Comprehensive Report is updated.
PEP BINDER DOCUMENTS - Inserts for your "Clinical Nutrition Program and Personal Education Program (PEP) Binder, which we call the PEP Binder.
SPECIAL WEB PAGESNote: if you are unable to find a form (or questionnaire) on the "All Forms & Questionnaires" webpage, this means that the form you seek is a special services form available to clients after payment for the specific service that uses the form and, therefore, have their own web page. Because new special services web pages may be added at any time, we have listed the special services web pages below that are were posted at the time of this writing, so you have an idea of the difference between "All Client" and "Special Services" web page forms and questionnaires, Therefore, not all of the special services web pages may be listed below. Also, each of these web pages have their own passcodes which are provided to the client upon payment for the service.
ANTI-AGING PROGRAM (Skin, Hair and Nails) - This web page provides an e-book for how to use Dr. Smith's skin, hair and nail personal care products so you can nourish and detoxify "externally" these areas of the body to slow down and reverse the signs of aging, where possible, such as repair skin that has scars or wrinkles, improve texture, shine and health of hair, etc.
DENTAL HEALTH PROGRAM - This web page contains educational information, charts, diagrams, forms, etc., for dental health both the biochemistry of dental health and holistic dentistry procedures. An overview of therapeutic supplement protocols for toothaches, abscesses, gum diseases, and healthier alternatives for root canals, implants and filling cavities, rather than using mercury/silver fillings.
DIETARY PROGRAM - This web page contains all questionnaires, forms and other dietary documents for the Dietary Program. Passcodes to open this web page are provided to clients who have paid for a Dietary Analysis.
DYSBIOSIS PROGRAM - This web page provides the Dysbiosis Program Instructions and Dysbiosis Questionnaire (2 pages). Passcodes to open this web page are provided to clients who have paid for the Dysbiosis Program.
FULL BODY DETOXIFICATION PROGRAM - This web page provides all the instructions and forms for completing a 30- Day Therapeutic Full Body Detoxification Program.
HEALTH CHEST - This web page provides the e-book for "Updating Your Medicine Chest to a Health Chest," i.e., what to use instead of drugs for first-aide, the flu, cuts, burns, insect or spider bites, etc. In other words, for any acute symptom or any event that can happen to you in daily life.
LIFESTYLE COACHING - This web page contains all forms and questionnaires for lifestyle coaching - improving your health includes making changes in your lifestyle that is also contributing to ill health and disease.
MIND - BODY MAINTENANCE - This web page contains all educational information, forms and questionnaires for understanding how the mind affects the body, how your brain works, and how to improve and maintain mental and emotional health. If the mind and emotions are unhealthy, in time, the physical body will become unhealthy, too.
SPORTS NUTRITION - This web page contains all questionnaires, forms and instructions for clients who have paid for our sports nutrition services.
Below is a quick link to each of the web pages discussed above.