Please print out and complete this form and bring it with you to your appointment: The New Client Intake Form asks you for scores from several of the questionnaires below.
You will need the scores from: the Metabolic Profile, the Enzyme Questionnaire, and the Candida Questionnaire. It is also helpful to have your Blood Type.
If you are a long distance client, you will mail this form in, along with a sample of your hair (enough to cover the size of a quarter), taken from any place on your head (colored or permed hair is fine too). Put the hair in a baggie and label it with your name.
If you have supplements you are currently taking and would like Cheryl to work with those, in putting together your protocol, please put one of each in an individual baggie, label them and include them with your packet.
Mail to: Lifestyle for Health, 993 Greenland Forest Dr., Monument, CO 80132
On many of her videos, Facebook posts and webinars Cheryl references these self-administered tests and resources as a basis for gathering information about you and your body. Click on the links below to download these forms.
If you are coming in for an appointment or if you are mailing in paperwork for a long distance appointment, the scores from these questionnaires will go on your New Client Intake Form.
There is no questionnaire for this. If you don’t know your blood type, you can ask your doctor (there will probably be a fee that is not covered by your insurance). The easiest way to determine your blood type is with an Eldoncard Blood Type Test Kit, that can be ordered from Amazon. They are usually less than $10.
Kits are single use, so you need one for each person you are testing.
Getting the right food for you is the first step. However, if you are under any stress and/or you eat primarily cooked foods, chances are, your enzyme reserves are lacking.
Without adequate digestion, you can experience
- Headaches and Backaches
- Constipation and/or Diarrhea
- Immune Challenges
The enzyme questionnaire allows you to identify the best blend of enzymes to ensure your body is getting its adequate dietary needs met through proper and complete digestion and assimilation. When you have the proper blend of enzymes you will notice marked improvement in energy and mental clarity. Enzymes can be used for both digestive support as well as for therapeutic purposes (when dealing with certain health issues).
Your metabolic profile helps you determine the best ratio of proteins, fats and carbohydrates for your body. Without a doubt, knowing your metabolic profile will help you to know if you do better grazing, eating high (healthy) proteins or if you are better with a more balanced blend of protein, carbs and fat for your diet. Your blood type helps you determine the best sources of food to match your metabolic type.
Candida is a yeast organism that normally lives in the mouth, on the skin, in the intestinal tract and in the vaginal tract of females. It is estimated that over 80% of the U.S. population has some form of Candida overgrowth. Candida can have a negative impact on your energy, mental clarity and be responsible for both weight gain and the inability to lose weight.
Health is based on a triangle. One leg is structural (spine, muscle, bone, teeth, etc.). One leg is nutritional (food, supplements, etc.). The third leg is emotional. This third leg is the realm that many practitioners leave out.
The emotional questionnaire helps you identify a flower essence(s) that could help aid in working through emotional issues. While Flower Essences do not solve problems; they are catalysts for staying calmer while working through issues and for supporting and stabilizing your emotions.
Flower essences are made like herbal tinctures, from the flower portion of herbs. My book, Discovering Wholeness, gives an excellent overview on flower essences, emotional connections to disease and how to use these remedies in adults, children and/or pets.
Thousands of people from around the world have worked with Cheryl Townsley as a Naturopath, Wisdom Coach and Home Economist, through her Lifestyle for Health Wellness Clinic. The most common feedback is, “Cheryl is so practical, she just makes sense. I can and want to do this!”
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