5800 Monroe St. A11 Sylvania, OH

Allergy Evaluation & Treatment

Are you feeling sick but can’t find the reason why?

Have you ever been tested for the link between what you eat and how you feel? Many times perfectly good foods may not be good for you and cause or aggravate your nagging symptoms. A simple blood test and the resulting diet modification will relieve symptoms such as arthritis, IBS, headache, overweight/underweight, hypertension, diabetes, chronic fatigue, asthma, & sinusitis to name a few.
Evaluate yourself below. Rate each of your symptoms based upon how you have been feeling during the past 30 days. Use the following 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 If your overall total score exceeds 10, then an IgG Delayed Food Allergy test is recommended.

Joints & Muscles

______ Pains or aches in joints ______ Arthritis ______ Stiffness, limited movement ______ Pain or aches in muscles ______ Feeling weak or tired ______ Swollen, tender joints ______ Growing pains in legs ______ Total


______ Mood swings ______ Anxiety, fear, nervousness ______ Angry, irritable, aggressive ______ Argumentative ______ Frustrated, cries often ______ Depression ______ Total


______ Binge eating/drinking ______ Craving certain foods ______ Excessive weight ______ Compulsive eating ______ Water retention ______ Total


______ Frequent illness ______ Frequent or urgent urination ______ Genital itch or discharge ______ Anal itching ______ Total

Digestive Tract

______ Nausea & Vomiting ______ Diarrhea ______ Constipation ______ Bloated feeling ______ Belching or passing gas ______ Stomach pains or cramps ______ Heartburn ______ Blood or mucous in stools ______ Total

Energy & Activity

______ Apathy, lethargy ______ Attention deficit ______ Fatigue ______ Hyperactivity ______ Restlessness ______ Poor physical coordination ______ Stuttering or stammering ______ Slurred speech ______ Total


______ Poor memory ______ Difficulty completing projects ______ Difficulty with mathematics ______ Underachiever in school ______ Poor/short attention span ______ Confusion ______ Easily distracted ______ Making decisions ______ Learning disabilities ______ Total


Total of All Sections: _______ If your grand total is higher than 10, please call us to schedule a personal consultation today. You don’t need to suffer any longer! Mention “Toxic Food Syndrome” and receive that book as a gift from us at your next appointment.

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