defense Name * First Name Last Name Email * Phone * (###) ### #### Message Do you tend to get every cold and flu that goes around? * Yes No Do you have sore joints that are made worse by modest exercise? * Yes No Ever get skin rashes of unknown origin? * Yes No Are you usually sensitive to the sun? * Yes No Do your joints swell up? * Yes No Do you suffer chronic pain in your hands, wrists, ankles, or feet? * Yes No Is your grip getting weaker? * Yes No Are you losing muscle? * Yes No Do you have chronic sinus infections? * Yes No Are fungal infections-like athlete's foot, for example-a common occurrence? * Yes No Do you have frequent bladder or urinary tract infections? * Yes No Do you have chronic intestinal pain or discomfort? * Yes No Do have dental problems associated with periodontal disease? * Yes No Does it feel to you that your leg or back pain is chronic? * Yes No Do you take anti-inflammatory medication regularly? * Yes No Have you ever been diagnosed with any of the following? * Epstein-Barr virus Herpes virus Candida albicans Lyme disease A waterborne parasite like Entamoeba histolytica or Cryptosporidium parvum HIV Cytomegalovirus Clostridium Thank you!