Discovery Diagnostic Name Gender MF Date Email Phone: Do you fall asleep as soon as your head hits the pillow? Do you feel tired or lethargic even after a full night’s sleep? Do you get 7-8 hours of sleep? Do you have difficulty staying focused? Do you experience frequent colds or flus? Do you have joint pain or stiffness? Do you have frequent headaches? Have you had a change in body odor or taste in your mouth? Do you have dark circles under your eyes? Does your skin lack ‘luster’ or a healthy glow? Are you struggling with weight loss or overweight? Do you have eczema, acne or psoriasis? Do you have constipation (less than one bowel movement per day)? Do you have gas, bloating or indigestion? Do you look puffy or bloated? Do you have high cholesterol or fatty liver disease? What is your biggest challenge? Time, Money, Family or Yourself Where do you gain your weight? Explain some of your eating habits: Do you exercise? Y/N If yes, explain: Anything else you would like me to know about you?