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Colon Health Assessment

Our time is valuable, please do not complete the FREE Candida Assessment unless you are
serious about dealing with your problems and are willing to speak to one of our experienced
consultants concerning your assessment.

Note: This information is confidential and will not be traded or sold to any other company or organization.*

We do not respond to incomplete or fake information.

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Colon Information
(Check current and past symptoms.)
Diarrhea Diverticulitis Irritable Bowel	Spastic Colon Chronic Constipation Ulcers


Additional Information for Colon Health Assessment Rate your exposure to automobile exhaust: Light Moderate Severe (Check current and past symptoms.)
Acne Adrenal/Thyroid Allergies Anti-social Asthma Athlete's Foot ADD/ADHD Bad Breath Bladder Infections Body Odor Breast Pathology Bronchitis Burning Eyes Cardiac Irregularities Cold/Shaky Chemical Sensitivity Coated Tongue Colds & Flu Colitis Colon Cancer Constipation Cystitis Depression	Diabetes Dry Mouth Dry & Itching Skin Ear and Respiratory Infections in Children Excessive Ear WaxItching Ears Endometriosis Sciatica Epstein Bar Virus Eye, Ear, Nose, & Throat Chronic Fatigue Failing Memory Fibromyalgia Salt, Fat, Sugar Cravings Foul Breath Fungal Nails & Toenails Gall Bladder Problems Gas/Bloating Gastritis Problems Headaches Heartburn Heart Palpitations Heart Skips Beats	Hemorrhoids Herpes Hiatal Hernia High Estrogen Levels Hormone Imbalance Hyperactivity Indigestions Infections Insomnia Intestinal Pain Irritability Lethargic/Laziness Liver Problems Low Blood Sugar Lowered Immunity Lupus Menstrual Problems Migraine Headaches Mood Swings Muscle Aches Nausea No Sex Drive Itch Around Nose	Numbness Oral Herpes Ovarian Cancers Over-all Bad Feeling PMS PMS Symptoms Poor Memory Premature Aging Puffy Eyes Receding Gums Respiratory Problems Sinus Skin Rashes & Hives Stomach BloatingStomach Cramps Thrush Tongue CoatingTonsillitis Urinary-Tract Infections Weakness Weight Gain Weight Loss Yeast Infections

Please tell us about your past/current health problems.

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Colon Health Assessment

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