• HEALTH ZONES SELF-ANALYSIS QUESTIONNAIRE

    The six sections of this form deal with the SIX HEALTH ZONES: Glandular, Eliminative, Nerve, Digestive, Muscular, Circulatory. By completing this form, it will assist us in determining which Zone / Function of the body is causing or contributing to your pain or problem. Since all six Zones are interrelated, an improvement in any one Zone would also affect the others.
  • Date Format: MM slash DD slash YYYY

  • INSTRUCTIONS

  • Circle the appropriate number for each question according to the following scale:


  • ZONE ONE – GLANDULAR


  • ZONE TWO – ELIMINATIVE


  • ZONE THREE – NERVE


  • ZONE FOUR – DIGESTIVE


  • ZONE FIVE – MUSCULAR


  • ZONE SIX – CIRCULATORY