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Life Style Survey & Support


Please mark the appropriate boxes below to learn which of your body systems need the the most strengthening, based on your responses, and which Nature's Sunshine products can be used to strengthen these systems.

Lack of energy
Illness more than twice a year
Body odor and/or bad breath
Difficulty in digesting certain foods
Eat meat more than 3 times/week
Monthly female concerns
Recent or frequent use of antibiotics
Regular consumption of Alcohol
Frequent mood swings
Food allergies
Bags under eyes
Smoking
Poor concentration and/or poor memory
Poor resistance to disease
Belching or gas after meals
Stressful lifestyle
Skin/complexion problems
Cravings for sweets and/or processed foods
Regular consumption of dairy products (milk, cheese, cream, butter, ice cream)  
Feeling low, uninterested, angry
Too little sleep or restless sleep
Menopausal concerns
Frequent urination or urinary concerns
Hair Loss
Sore or painful joints
Difficulty in maintaining ideal weight
Low endurance/stamina
Lack of balanced diet
Slow recovery from illness
Less than 2 bowel movements per day
Lack of appetite
Low sex drive
Brittle or easily broken fingernails
Dry, damaged or dull hair
High fat diet
Unsettled, apprehensive, pressured
Low fiber diet (Not enough fruits)
Muscle cramps or spasms
Exposure to air pollution daily
Cokes, sodas, caffeine consumptiondaily
Feeling out of control
Food/Chemical sensitivities
Recurrent yeast/fungal infections
Weak bones, teeth or cartilage
Suffer from anxiety or worry
Easily irritated or angered
Do not exercise regularly
Respiratory, sinus or allergy problems


FAMILY "HEALTH" HISTORY
For each blood relative who had a major health issue such as
heart attack, stroke, cancer, diabetes, alzheimer's
check the appropriate box below.


On your Father side
Heart/Circulation
Stroke
Cancer
Diabetes
Alzheimer's
Your Father's Father
Your Father's Mother
Your Father
Aunts and Uncles
Siblings
Brother
Sister



On your Mother side
Heart/Circulation
Stroke
Cancer
Diabetes
Alzheimer's
Your Mother's Father
Your Mother's Mother
Your Mother
Aunts and Uncles
Siblings
Brother
Sister


   OR