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FOOD PHARMACOLOGY
All about HERO FOODS
ABOUT
WHO WE ARE
WE HELP WITH
PHARMA SERVICES
INDIVIDUAL SERVICES
CORPORATE SERVICES
WORKSHOPS & PROGRAMS
SUPPORT
COOKING & LIFESTYLE VIDEO
HEALTHY RECIPE
PHARMA TALK
COMMUNITY
ANALYSIS_Physical problems
PHYSICAL PROBLEMS
MUSCULOSKELETAL
Aching muscles/joints
Arthritis
Low back pain
Vertebral disc problem
Torn ligaments/muscle soreness
Osteoporosis/Osteopenia
Other
Describe if you choose other
SKIN
Infection (boils, ulcers, etc.)
Chronic rashes
Bruises easily
Excessive hair growth (females)
Other
Describe if you choose other
Any conditions such as...
Low energy level Depression, Bipolar,ADD
Anxiety disorder, OCD,
Panic attacks
Psychological/Psychiatric care
History of child abuse/rape/molestationHistory of any physical violence
History of cancer
Anemia
Sickle cell disease
Headache
What is the most active thing you do in an average day?
What, if any, regular exercise do you participate in? How often? (describe)
What physical activity would you like to do that you are currently not doing?
Do you feel pain in your chest or shortness of breath when you do physical activity?
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
Yes
No
Do you have a bone/joint problem that may worsen by changes in your activity?
Yes
No
Do you know any other reason why you should not do physical activity?
Yes
No
Age
D.O.B
Phone Number
Email
Name
Occupation
Normal work hours
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