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Metabolic Health Assessment

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This assessment presents questions that your healthcare practitioner can use to determine which body systems require further investigation. It is brought to you by Biotics Research Corporation.

Instructions: Enter your information below. Rate each of the following symptoms based upon your typical health profile.

Last Name
*Difficulty gaining weight, even with large appetite
*Nervous, emotional, can’t work under pressure
*Flush easily
*Fast pulse at rest
*Inward trembling
*Intolerance - high temperatures
Difficulty losing weight
Mentally sluggish, reduced initiative
Easily fatigued, sleepy during the day
Sensitive to cold, poor circulation (cold hands and feet)
Excessive hair loss and/or coarse hair
Morning headaches, wear off during the day
Loss of lateral 1/3 of eyebrow
Infrequent bowel movements
Craves Sweets
Irritable if missed meals
Light headed if meals are missed
Frequent urination
Frequent thirst
Fatigue after meals
Eating relieves fatigue
Agitated or easily upset
Blurred vision
Headache if meals are missed
Poor memory/forgetful
Shaky if missed meals
Binge or uncontrolled eating
*Cannot fall asleep; wake up after a few hours of sleep
*Perspire easily
*Wake up tired – after 6+ hours of sleep
*Tend to be “keyed up” during the day
*Clenched or grind teeth
*Excessive thirst
Crave salty foods
Cannot stay asleep. Awaken after a few hours of sleep
Slow starter in the morning
Afternoon fatigue
Become dizzy when standing up suddenly
Weak nails
Weakness / Dizziness
Afternoon yawning
Allergies or hives
Arthritic tendencies
Chemical & odor sensitivities
Headaches after exposure to chemicals
Intolerance to household chemicals (e.g. shampoo, lotion, laundry detergent, etc.)
Skin outbreaks
Excessive mucus
Bloating and distention after eating
Intolerance to sugars & starches - upset the stomach
Abdominal swelling
Increased reactions to eating foods
Pains, aches and swelling throughout the body
Unpredictable food reactions
Skin issues: acne, rosacea
Bad breath (halitosis)
Heartburn or acid reflux
Excessive belching or burping
Undigested foods in stool
Gas after meals
Difficult bowel movements
Sense of excess fullness after meals
Sleepy after meals
Hormone imbalances
Light colored stools
Pain between shoulder blades
Stomach upset after greasy foods
Acne or unhealthy skin
Hemorrhoids or varicose veins
Dry or flakey skin
Itchy skin
Removal of gallbladder
Gallbladder attacks
Headache over eyes

Disclaimer: This personal assessment is not diagnostic of any health condition. It is designed to help licensed health practitioners organize varied body occurrences that, when viewed as an organized whole, may lead to a common factor.