Follow the Physiology Survey

Follow The Physiology Survey is the best, most comprehensive written survey of your health, health problems, potential causes, mechanism, and the clinical symptom picture arising from organ dysfunction. It helps your practitioner tremendously to determine your best path to wellness. Remaining questions are discussed during your consultations. I created the Follow The Physiology Survey because there wasn’t any health and wellness survey good enough that Followed The Physiology. I looked at surveys that measure stress, toxicity, mental health, symptoms, mold, and body function but none were adequate to get a great wellness plan together. Follow The Physiology Survey can identify potential issues and very importantly rule out problems, too. Causes like immune challenges and bioburden from parasites, mold, fungus and other organisms can be discovered. It can determine if toxicity is a potential issue or not. It can see what organs are being affected by the causes. It can determine if your best diets should be the anti-viral diet, the anti-fungal diet, the ketogenic diet, the paleo diet, whole30 diet, or another diet. It can see if you have one of the two mechanisms of chronic disease. Once you fill out the survey, you can get a consultation and solutions once you become a patient. Yours in Health, Darren Schmidt, D.C.

Approximately how many YouTube videos of Dr. Schmidt have you seen?*
Do you understand what Ketosis is?*
- Yes
- No
- Maybe
Do you understand what Lactic Acidosis is?*
- Yes
- No
- Maybe
How would you describe your current diet?*
Did you start changing your diet once you started watching Dr. Schmidt’s YouTube videos?*
- Yes
- No
Since watching Dr. Schmidt’s YouTube videos, have you changed your diet?*
Are you using Cronometer to track the macronutrients in your diet?*
- Yes
- No
Are you testing for ketones via urine, breath, or blood?*
- Yes
- No
Do you still have your gallbladder?*
- Yes
- No
List your top five health symptoms in order of importance.*
What occurred just before you started to lose your health that may be contributing or causing your current health condition? For example, any specific physical trauma or life stress? Dental work? Vaccine? Bad diet? Too much alcohol or medications?*
Surgeries: Please list any surgeries and approximate dates:*
Injuries: Please list any major accidents or injuries and approximate dates*
Sleep:*
Any other sleep problems?*
Exercise: What kind of exercise do you do?*
Exercise: How often? _____ Duration?*
Food Allergies: Please list*
Are you coachable?*
- Yes
- No
Is your health an investment or an expense?*
- Investment
- Expense
How many root canals do you have?*
How many mercury fillings do you have?*
Have you ever had mercury fillings taken out? If yes, was it down by a “biological dentist” meaning there were specific procedures and filters to prevent mercury vapor inhalation?
On a scale of 0-10, 0 is “dead,” 10 is “perfect,” where is your overall health?*
Please list your medications you are currently on and how many years for each:*
Please list supplements or herbs that have helped you feel better:*
Please list the supplement(s) and/or herbs you are on right now.*
What lab results do you have that concisely tell us about your physical health?*
How often do you drink alcohol?*
How often do you smoke?*
What is your blood pressure average?*
Bioburden
Definition: Degree of microbial contamination or microbial load; the number of microorganisms contaminating an object.
Has a doctor or a blood test said you’ve had multiple infections at once?*
- Yes
- No
Have you ever had to treat one organism followed by a different one soon after?*
- Yes
- No
Virus
Do your symptoms get worse after eating nuts, seeds, and nut butters like peanut butter?*
- Yes
- No
- Maybe
Do you catch colds or the flu too easily?*
- Yes
- No
Candida/ Yeast/ Mold
Have you ever felt like your body was collapsing suddenly while feeling no pain?*
- Yes
- No
Do you have a white coating on your tongue?*
- Yes
- No
- a little
Do you have a rash on your skin?*
- Yes
- No
Do you have a history of fungal or yeast infection?*
- Yes
- No
Have you lived in a moldy house or worked in a moldy building?*
- Yes
- No
Do you have mucus in stools?*
- Yes
- No
Are your symptoms worse at night?*
- Yes
- No
Bacteria
When you catch a cold or similar illness, are you frequently coughing up green phlegm?*
- Yes
- No
Do you frequently use antibiotics?*
- Yes
- No
Do you get benefits from using antibiotics?*
- Yes
- No
Parasites
Have you ever had parasites before? You’ve actually seen worms in your bowel movements?*
- Yes
- No
Parasites love the full moon. Do you feel worse during the full moon?*
- Yes
- No
Do you get itchy anus?*
- Yes
- No
Are you too easily bloated in the abdomen?*
- Yes
- No
Have you consumed a lot of sushi in the past?*
- Yes
- No
Is your appetite excessive?*
- Yes
- No
Do you grind your teeth at night?*
- Yes
- No
Toxicity
Have you ever had a metallic taste in your mouth?*
- Yes
- No
Does your body ever smell like garlic or onion even though you didn’t eat any?*
- Yes
- No
Do you have a history of getting regular vaccines?*
- Yes
- No
Have you worked or lived in an environment that was/is toxic or had chronic exposures?*
- Yes
- No
Do you ever get better with various treatments but then get worse again even when your diet is good?*
- Yes
- No
Do you have trouble losing weight even though your diet is excellent?*
- Yes
- No
Are you sensitive to smells, including chemicals such as petrochemicals, perfumes, air fresheners?*
- Yes
- No
Brain
Does your brain work well or are you missing words, memories, speed, and/or clarity?*
- Works well
- Doesn’t work well
What part of your head hurts if/ when you get headaches?*
Do you look at a computer screen too long and try to avoid looking at it because your brain is tired?*
- Yes
- No
Does the back of the head hurt? This could include upper neck pain.*
- Yes
- No
Do you get tired eyes?*
- Yes
- No
Do you have sleep apnea?*
- Yes
- No
Bladder/ Kidneys
Do you get frequent or urgent urination?*
- Yes
- No
Do you have a leaky bladder?*
- Yes
- No
Does your body smell like urine?*
- Yes
- No
Do you have genital itch or discharge?*
- Yes
- No
Liver
Do you have yellowish eyes or skin?*
- Yes
- No
Do you have chronic right shoulder pain?*
- Yes
- No
Do you get chronic right knee pain?*
- Yes
- No
Do you get pain below the right rib cage?*
- Yes
- No
Gall Bladder
Do you get pain on the right side of your torso below your rib cage especially after eating?*
- Yes
- No
Do you suffer from constipation?*
- Yes
- No
Do you suffer from diarrhea?*
- Yes
- No
Do you often alternate between constipation and diarrhea?*
- Yes
- No
How many bowel movements do you have per day?*
Do you get abdominal bloating from eating fats?*
- Yes
- No
Do you experience “urps”? It’s like a burp and hiccup combined*
- Yes
- No
Have you ever had any stone form including kidney stone, liver stone, or gal bladder stone?*
- Yes
- No
Heart
Do you get pain in the heart area?*
- Yes
- No
Do you have a chronic pain in the left shoulder but not the right?*
- Yes
- No
Do you get a tightening feeling under the breastbone?*
- Yes
- No
Ears
Do your ears itch?*
- Yes
- No
Does one or both of your ears feel like there is fluid or congestion in them?*
- Yes
- No
Do you get drainage out of your ears?*
- Yes
- No
Did you get a lot of ear infections as a child?*
- Yes
- No
Did you go on a lot of antibiotics as a child?*
- Yes
- No
Do you feel “post-nasal drip,” the tickle in the back of your throat from liquid dripping down causing a dry cough?*
- Yes
- No
Adrenal
Do you get mid back pain on either side of the spine? It may move from side to side accompanied with fatigue.*
- Yes
- No
Do you have chronic pain between shoulder blades?*
- Yes
- No
Do you crave salt?*
- Yes
- No
Sinus/ Lungs
Are your nose and sinus mucousy or stuffy?*
- Yes
- No
Do you need to clear throat often?*
- Yes
- No
Do you have chronic coughing?*
- Yes
- No
Do you have sinus pain or pressure in the face?*
- Yes
- No
Female Hormones
Do you get PMS?
- Yes
- No
Do you get hot flashes?
- Yes
- No
Do you have a diminished sex drive?
- Yes
- No
Other female symptoms not yet mentioned?
Are you pregnant?
- Yes
- No
Are you nursing?
- Yes
- No
Date of onset of last menstrual period:
Do you have regular monthly periods?
- Yes
- No
Mark any of the following symptoms you experience associated with your period:
- Cramping
- Bloating
- Moody
- Cravings
- Heavy Bleeding
- Back Pain
- Headaches
- Clots
Male Hormones
Do you get urination symptoms from prostate: Slow flow, dripping at the end, etc.?
- Yes
- No
Do you have erectile dysfunction?
- Yes
- No
Do you experience a diminished sex drive?
- Yes
- No
Sugar Handling
Do you crave sweets?*
- Yes
- No
How many hours can you go between meals without getting hungry or irritable?*
Date Coincident Scars
Ask yourself if you had any symptoms arise AFTER you received a scar somewhere on your body. This includes an episiotomy tearing and piercings.
Pituitary
Do you get headache pain at sides of the head, especially the left side?*
- Yes
- No
Do you experience severe acid reflux or heartburn?*
- Yes
- No
Nervous System
When you turn your head fast or jump up and down, does it feel like you leave your body a little bit?*
- Yes
- No
Do you experience nerve pain down the legs (sciatica) or had a diagnosis of neuropathy or neuritis?*
- Yes
- No
Lymphatic System
Do you get a congestion feeling in the armpits?*
- Yes
- No
Do you have swollen glands under your chin, jaw, or neck?*
- Yes
- No
Stomach
Do you have trouble eating meat/lean beef?*
- Yes
- No
Do you get heartburn from drinking water on an empty stomach?*
- Yes
- No
Pancreas
Do you have trouble with salads?*
- Yes
- No
Thyroid
Do you have a headache when waking, then wears off as the morning goes by?*
- Yes
- No
Do you have unexpected weight gain with no change in diet?*
- Yes
- No
Do you have dry skin?*
- Yes
- No
Do you lack motivation?*
- Yes
- No
Can you feel your heart beating irregularly?*
- Yes
- No
Types of Fatigue
Are naps during the day refreshing?*
- Yes
- No
Does your body feel heavy? Do you have to drag the body around with effort?*
- Yes
- No
Does your brain feel tired? Your head is heavy and worse at the end of the work week?*
- Yes
- No
Do you experience fatigue mostly after meals?*
- Yes
- No
Does it seem your fatigue is constant throughout the day?*
- Yes
- No
Do you wake in the morning still tired?*
- Yes
- No
On scale of 0-10 how bad is your fatigue? Zero is no fatigue during the day at all. 10 is the worst fatigue you can imagine.*
Types of Joint Pain
Do you experience traveling pain?*
- Yes
- No
Do you get pain 1 hour after falling asleep?*
- Yes
- No
Do you have pain between your shoulder blades?*
- Yes
- No
The remaining questions are to determine if you have the potential of too much lactic acid in your blood while also having too little oxygen. This causes cell death and is the basic premise of most chronic disease.
Part 1: Body, Muscles, Arms, Legs
1) Do you get bouts of body fatigue and/or weakness? (can be extreme like Chronic Fatigue Syndrome)*
- Yes
- No
2) Do your muscles get achy or sore too easily? Could be extreme like Fibromyalgia*
- Yes
- No
3) Do you have nerve tingling in arms or face?*
- Yes
- No
4) Do your ankles swell?*
- Yes
- No
5) Do you get a deep ache in the calves?*
- Yes
- No
6) Do you get muscle cramping?*
- Yes
- No
7) Do you experience digestive symptoms like nausea, loss of appetite, or acid reflux?*
- Yes
- No
8) Do you have an underactive thyroid?*
- Yes
- No
9) Is your core body temperature cold?*
- Yes
- No
10) Do you have poor circulation to hands and feet?*
- Yes
- No
Part 2: Chest, Lungs, Heart
11) Do you have any kind of asthma?*
- Yes
- No
12) Do you get narrowing or tightening feeling in the chest or chest pain?*
- Yes
- No
13) Do you ever get a choking sensation, throat fullness, esophageal spasm?*
- Yes
- No
14) Do you experience heart pounding or palpitations?*
- Yes
- No
15) Do you experience difficulty breathing or shortness of breath?*
- Yes
- No
Part 3: Brain
16) Do you have anxiety?*
- Yes
- No
17) Do you get bad thoughts like fear, grief, or depression?*
- Yes
- No
18) Do you ever want to leave an area without a logical explanation?*
- Yes
- No
19) Are you obsessive-compulsive?*
- Yes
- No
20) Do you get dizzy?*
- Yes
- No
21) Do you get violent thoughts?*
- Yes
- No
22) Do you ever feel fear of impending doom?*
- Yes
- No
23) Do you get intrusive thoughts especially “I can’t...” or questioning your life decisions?*
- Yes
- No
24) Do you avoid the friction of social contact?*
- Yes
- No
25) Have you ever medicated this pain through drugs, alcohol, or medications which make it better temporarily but in the long run make it worse and may have caused addiction?*
- Yes
- No
26) Have you been super stressed out over one or more life events that you never recovered from?*
- Yes
- No
27) Have you been eating or did you grow up on bread, pasta, sugar, or rice?*
- Yes
- No
28) How many hours can you go between meals without eating?*
More Questions
Are you willing to do whatever it takes to correct your condition even if it involves lifestyle changes?*
- Yes
- No
How committed are you to making these lifestyle changes on a scale of 1-10 with 10 being 100% committed?*
Are you financially ready to commit to getting your life back?*
- Yes
- No
What three goals/expectations do you want out of our program?*
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*

Follow The Physiology Survey

Bioburden

Virus

Candida/ Yeast/ Mold

Bacteria

Parasites

Toxicity

Brain

Bladder/ Kidneys

Liver

Gall Bladder

Heart

Ears

Adrenal

Sinus/ Lungs

Female Hormones

Male Hormones

Sugar Handling

Date Coincident Scars

Pituitary

Nervous System

Lymphatic System

Stomach

Pancreas

Thyroid

Types of Fatigue

Types of Joint Pain

The remaining questions are to determine if you have the potential of too much lactic acid in your blood while also having too little oxygen. This causes cell death and is the basic premise of most chronic disease.

Part 1: Body, Muscles, Arms, Legs

Part 2: Chest, Lungs, Heart

Part 3: Brain

More Questions